Provider Demographics
NPI:1497095632
Name:GALLO, MARY LAURETTE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LAURETTE
Last Name:GALLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13 OPAL COMMONS
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-9620
Mailing Address - Country:US
Mailing Address - Phone:360-302-0978
Mailing Address - Fax:360-376-5183
Practice Address - Street 1:13 OPAL COMMONS
Practice Address - Street 2:ISLAND HOSPITAL
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9620
Practice Address - Country:US
Practice Address - Phone:360-302-0978
Practice Address - Fax:360-376-5183
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN150147163WG0000X, 163WP1700X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No374J00000XNursing Service Related ProvidersDoula