Provider Demographics
NPI:1518599778
Name:GALLINA, EVA MARIA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIA
Last Name:GALLINA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 CHARLESTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7390
Mailing Address - Country:US
Mailing Address - Phone:314-401-4046
Mailing Address - Fax:
Practice Address - Street 1:4525 MID RIVERS MALL DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2820
Practice Address - Country:US
Practice Address - Phone:636-229-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019042613363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics