Provider Demographics
NPI:1619667656
Name:GALLINA, ASHLEY RAE (APRN, CNM, FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:GALLINA
Suffix:
Gender:F
Credentials:APRN, CNM, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9208
Mailing Address - Country:US
Mailing Address - Phone:815-363-2020
Mailing Address - Fax:
Practice Address - Street 1:214 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9208
Practice Address - Country:US
Practice Address - Phone:815-363-2020
Practice Address - Fax:224-225-1003
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024423367A00000X
IL209.031083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife