Provider Demographics
NPI:1194527952
Name:GALLANOSA, MARIA GABRIELLE (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELLE
Last Name:GALLANOSA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GABRIELLE
Other - Last Name:SHALLENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4116 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-8801
Practice Address - Country:US
Practice Address - Phone:317-369-8574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041523872163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant