Provider Demographics
NPI:1710331749
Name:DANILY, GALINA ELIZABETH (ND)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:ELIZABETH
Last Name:DANILY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 SE LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5984
Mailing Address - Country:US
Mailing Address - Phone:503-984-9010
Mailing Address - Fax:
Practice Address - Street 1:11630 SE 40TH AVE STE C
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6195
Practice Address - Country:US
Practice Address - Phone:503-984-9010
Practice Address - Fax:844-229-5874
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3090175F00000X
WANT60647451175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500707480Medicaid
WA2059335Medicaid