Provider Demographics
NPI:1033691159
Name:GALLOFIN, VIVIAN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:GALLOFIN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MI
Mailing Address - Zip Code:48659-9548
Mailing Address - Country:US
Mailing Address - Phone:989-793-3448
Mailing Address - Fax:
Practice Address - Street 1:725 E STATE ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9548
Practice Address - Country:US
Practice Address - Phone:989-654-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704266017163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse