Provider Demographics
NPI:1992037675
Name:KLYUZOVA, GALINA (RN)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:KLYUZOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 HORACE HARDING EXPY
Mailing Address - Street 2:APT. 12H
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4758
Mailing Address - Country:US
Mailing Address - Phone:718-699-1890
Mailing Address - Fax:
Practice Address - Street 1:97-11 HORACE HARDING EXPWAY
Practice Address - Street 2:APT. 12H
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-699-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615400-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health