Individual
NATALIE J GALLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3002 GILL ST, BLOOMINGTON, IL 61704-3438
(309) 664-7930
(309) 664-7931
Mailing address
28099 W ROCKWELL CT, LAKEMOOR, IL 60051-6606
(309) 664-7930
(309) 664-7931
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
Other
Enumeration date
04/17/2024
Last updated
04/17/2024
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