Individual
DELORES A GALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209000851
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041207588
RN LICENSE
IL
01
—
045954
CCNA CERTIFICATION
—
Enumeration date
03/01/2006
Last updated
02/21/2012
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