Provider Demographics
NPI:1760040190
Name:GAGLIANO, ANNA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6540
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-6540
Mailing Address - Country:US
Mailing Address - Phone:605-341-5565
Mailing Address - Fax:605-341-5595
Practice Address - Street 1:7236 JORDAN DR STE 101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8740
Practice Address - Country:US
Practice Address - Phone:605-341-5565
Practice Address - Fax:605-341-5595
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR044289OtherSOUTH DAKOTA BOARD OF NURSING
SDCP001570OtherSOUTH DAKOTA BOARD OF NURSING