Provider Demographics
NPI:1548428949
Name:GALANOS, LINDA ANN (RN, NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:GALANOS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-242-0614
Mailing Address - Fax:805-457-1550
Practice Address - Street 1:100 CASA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:805-242-0614
Practice Address - Fax:805-457-1550
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6628363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA364928OtherRN LICENSE #
CA6628OtherNP LICENSE #
CACB234327OtherMEDICARE ID
CA364928OtherRN LICENSE #
CAFA464YMedicare PIN