Provider Demographics
NPI:1285349712
Name:GALLUCCI, DAPHNE BREE (CRNP)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:BREE
Last Name:GALLUCCI
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 1:539 ASH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2021
Mailing Address - Country:US
Mailing Address - Phone:814-242-9796
Mailing Address - Fax:
Practice Address - Street 1:1111 FRANKLIN ST STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4340
Practice Address - Country:US
Practice Address - Phone:814-534-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026582363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner