MEDICARE: MRS. OLIVIA CLAIRE GALLUCCI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN60893930	WA

General Provider Information

NPI Number	:	1871266189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLIVIA CLAIRE GALLUCCI RN

Provider Business Mailing Address
First Line	:	1741 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2507
Country	:	US
Telephone Number	:	253-310-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 POTTERY AVE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2507
Country	:	US
Telephone Number	:	253-310-1448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2021
Last Update Date	:	08/01/2021

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