Provider Demographics
NPI:1710372065
Name:GALLIMORE, TABETHIA OPHERLIA (RN)
Entity type:Individual
Prefix:MS
First Name:TABETHIA
Middle Name:OPHERLIA
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 ARNETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619
Mailing Address - Country:US
Mailing Address - Phone:585-309-7228
Mailing Address - Fax:
Practice Address - Street 1:308 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2547
Practice Address - Country:US
Practice Address - Phone:525-281-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559072-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse