Provider Demographics
NPI:1356530851
Name:PERKINS, GALINA ANGELA (CRNA)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:ANGELA
Last Name:PERKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:ANGELA
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2643 E SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4972
Mailing Address - Country:US
Mailing Address - Phone:602-237-5596
Mailing Address - Fax:480-323-0299
Practice Address - Street 1:4800 N 22ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4701
Practice Address - Country:US
Practice Address - Phone:602-955-1000
Practice Address - Fax:602-508-4830
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN118303367500000X
AZCRNA0551367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ287032Medicaid