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Individual

CAROL T GALLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
1560 BEAM AVE STE E, MAPLEWOOD, MN 55109-1171
(651) 578-7000
(651) 773-9646
Mailing address
1560 BEAM AVE STE E, MAPLEWOOD, MN 55109-1171
(651) 578-7000
(651) 773-9646

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0710769
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
960961012135
PREFERRED ONE
MN
Enumeration date
04/25/2008
Last updated
04/25/2008
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