Provider Demographics
NPI:1982843504
Name:GALVIN, MARY JANE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:GALVIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2003
Mailing Address - Country:US
Mailing Address - Phone:203-453-2013
Mailing Address - Fax:203-453-6404
Practice Address - Street 1:405 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2003
Practice Address - Country:US
Practice Address - Phone:203-453-2013
Practice Address - Fax:203-453-6404
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily