Provider Demographics
NPI:1548807340
Name:GALLIK, DANA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:GALLIK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MY WAY LN
Mailing Address - Street 2:
Mailing Address - City:BEACH LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18405-3111
Mailing Address - Country:US
Mailing Address - Phone:570-637-1028
Mailing Address - Fax:
Practice Address - Street 1:1041 BEACH LAKE HWY STE 2
Practice Address - Street 2:
Practice Address - City:BEACH LAKE
Practice Address - State:PA
Practice Address - Zip Code:18405-3009
Practice Address - Country:US
Practice Address - Phone:570-801-9488
Practice Address - Fax:877-675-2576
Is Sole Proprietor?:No
Enumeration Date:2019-11-30
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN660596163WE0003X
PASP021359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency