Provider Demographics
NPI:1669602330
Name:GAYLE-GALLIMORE, ELIZABETH KAREN (LPN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KAREN
Last Name:GAYLE-GALLIMORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 SOUTHWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2825
Mailing Address - Country:US
Mailing Address - Phone:804-245-7452
Mailing Address - Fax:
Practice Address - Street 1:1118 SOUTHWICK BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2825
Practice Address - Country:US
Practice Address - Phone:804-245-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002080507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse