Basic Information
| Provider Information | |||||||||
| NPI: | 1417204355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLERT | ||||||||
| FirstName: | UTE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1077 | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144568077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7162130348 | ||||||||
| Practice Location | |||||||||
| Address1: | 369 E. MAIN STREET | ||||||||
| Address2: | HUNTINGTON LIVING CENTER | ||||||||
| City: | WATERLOO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155399202 | ||||||||
| FaxNumber: | 3155393495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 337383 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.