Provider Demographics
NPI:1760524821
Name:GALYON, AGATA D (CRNA)
Entity Type:Individual
Prefix:
First Name:AGATA
Middle Name:D
Last Name:GALYON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AGATA
Other - Middle Name:D
Other - Last Name:MANIKOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2732
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:903-735-9802
Practice Address - Street 1:6606 LYNDON B JOHNSON FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-233-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-346228367500000X
TX761977367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered