Provider Demographics
NPI:1306051560
Name:WALLENBECK, GAIL KATHLEEN (RN)
Entity type:Individual
Prefix:PROF
First Name:GAIL
Middle Name:KATHLEEN
Last Name:WALLENBECK
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:800 N STATE COLLEGE BLVD
Mailing Address - Street 2:STUDENT HEALTH & COUNSELING CENTER
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3547
Mailing Address - Country:US
Mailing Address - Phone:714-278-2832
Mailing Address - Fax:714-278-5525
Practice Address - Street 1:800 N STATE COLLEGE BLVD
Practice Address - Street 2:STUDENT HEALTH & COUNSELING CENTER
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3547
Practice Address - Country:US
Practice Address - Phone:714-278-2832
Practice Address - Fax:714-278-5525
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA244163163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health