Carol T Gallivan, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R0710769 Issued in MN

Practice address

1560 Beam Ave Ste E
Maplewood, MN 55109-1171

Phone

(651) 578-7000

Fax

(651) 773-9646

NPI assigned

Apr 25, 2008

Last updated

Apr 25, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maplewood Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1003993304
  NPD (past)
• True North Oral Surgery and Implants PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1285179945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1275708745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 BEAM AVE STE E",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091171",
            "telephone_number": "651-578-7000",
            "fax_number": "651-773-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 BEAM AVE STE E",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091171",
            "telephone_number": "651-578-7000",
            "fax_number": "651-773-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLIVAN",
        "first_name": "CAROL",
        "middle_name": "T",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R0710769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "960961012135",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Rose Gabor, MSSW, LGSW
• Gabriel Priority Care LLC
• Robert Adams Gaertner, M.D.
• John Frank Galatowitsch, MD
• Kevin Gale, MD
• Kathleen F Gams, CRNA
• Zamzam Garad
• Miguel Angel Garcia Lopez, DDS
• Oliver Garrison, M.D.
• Rachel Lynn Gates, CNM

• Registered Nurse in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.