Provider Demographics
NPI:1821247875
Name:GALLOW, GERALYN ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GERALYN
Middle Name:ANN
Last Name:GALLOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:GERALYN
Other - Middle Name:ANN
Other - Last Name:BERGERSTOELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:P.O. BOX 446
Mailing Address - Street 2:2301 SHERWOOD ROAD
Mailing Address - City:SCIPIO CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147
Mailing Address - Country:US
Mailing Address - Phone:315-364-5276
Mailing Address - Fax:
Practice Address - Street 1:2301 SHERWOOD ROAD
Practice Address - Street 2:
Practice Address - City:SCIPIO CENTER
Practice Address - State:NY
Practice Address - Zip Code:13147
Practice Address - Country:US
Practice Address - Phone:315-364-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse