Provider Demographics
NPI:1740251305
Name:GALLO, LAUREEN ANN (CRNP MSN)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:ANN
Last Name:GALLO
Suffix:
Gender:F
Credentials:CRNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EASTERN SHORE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5513
Mailing Address - Country:US
Mailing Address - Phone:410-912-6716
Mailing Address - Fax:
Practice Address - Street 1:400 EASTERN SHORE DR STE 204
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5513
Practice Address - Country:US
Practice Address - Phone:410-912-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001194155207R00000X
MDAC000295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146021800Medicaid
439M632FMedicare ID - Type Unspecified