Provider Demographics
NPI:1962153502
Name:GALLUCCI, MARY JEANINE (RN CCM)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEANINE
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:RN CCM
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Mailing Address - Street 1:1391 NW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2800
Mailing Address - Country:US
Mailing Address - Phone:224-517-6660
Mailing Address - Fax:770-723-8711
Practice Address - Street 1:804 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4776
Practice Address - Country:US
Practice Address - Phone:224-517-6660
Practice Address - Fax:770-723-8711
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041-212412163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management