Provider Demographics
NPI:1881763324
Name:GALLMAN, ELLEN CARY (DNP, APRN, RD)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:CARY
Last Name:GALLMAN
Suffix:
Gender:F
Credentials:DNP, APRN, RD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:BURNETT
Other - Last Name:CARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5048
Mailing Address - Country:US
Mailing Address - Phone:704-576-8986
Mailing Address - Fax:
Practice Address - Street 1:6675 BUSINESS PKWY STE F
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6349
Practice Address - Country:US
Practice Address - Phone:866-799-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002649133V00000X
SC20281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4029Medicaid