Provider Demographics
NPI:1619667656
Name:GALLINA, ASHLEY RAE (MSN, APRN-CNM)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:GALLINA
Suffix:
Gender:F
Credentials:MSN, APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4608
Mailing Address - Country:US
Mailing Address - Phone:847-999-7546
Mailing Address - Fax:
Practice Address - Street 1:114 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4608
Practice Address - Country:US
Practice Address - Phone:847-999-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024423367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife