Provider Demographics
NPI:1851863757
Name:LAGALA, DANAE NICOLE (LVN)
Entity Type:Individual
Prefix:MS
First Name:DANAE
Middle Name:NICOLE
Last Name:LAGALA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 RIVARA CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3720
Mailing Address - Country:US
Mailing Address - Phone:916-838-1999
Mailing Address - Fax:
Practice Address - Street 1:7415 HENRIETTA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5142
Practice Address - Country:US
Practice Address - Phone:916-520-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701191164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse