Provider Demographics
NPI:1043230279
Name:GALIAS, KATHERINE A (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:GALIAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 PINGREE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1725
Mailing Address - Country:US
Mailing Address - Phone:815-459-6655
Mailing Address - Fax:847-658-9922
Practice Address - Street 1:1095 PINGREE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1725
Practice Address - Country:US
Practice Address - Phone:815-459-6655
Practice Address - Fax:847-658-9922
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000683363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277000683OtherFULL PRACTICE AUTHORITY