Provider Demographics
NPI:1881168292
Name:GALLINA, DARLENE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:GALLINA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:MARIE
Other - Last Name:VANHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1325
Mailing Address - Country:US
Mailing Address - Phone:315-283-5619
Mailing Address - Fax:
Practice Address - Street 1:31 RIDGE ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1325
Practice Address - Country:US
Practice Address - Phone:315-283-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192933-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse