Provider Demographics
NPI:1619967395
Name:GALVIN, MARY EDITH (RNC FNP PHD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:EDITH
Last Name:GALVIN
Suffix:
Gender:F
Credentials:RNC FNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2793
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352
Mailing Address - Country:US
Mailing Address - Phone:909-336-4997
Mailing Address - Fax:
Practice Address - Street 1:29011 HOSPITAL RD
Practice Address - Street 2:STE 200
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-336-9715
Practice Address - Fax:909-336-5751
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA207865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner