Provider Demographics
NPI:1407160674
Name:GALLO MACRIE, KIM (LPN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:GALLO MACRIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ATLANTIC AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7022
Mailing Address - Country:US
Mailing Address - Phone:609-572-8800
Mailing Address - Fax:
Practice Address - Street 1:1401 ATLANTIC AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7022
Practice Address - Country:US
Practice Address - Phone:609-572-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05049300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse