Provider Demographics
NPI:1043915382
Name:GALLAGHER, CASEY LOUISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LOUISE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPRINGVALE RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1551
Mailing Address - Country:US
Mailing Address - Phone:617-640-2368
Mailing Address - Fax:
Practice Address - Street 1:113 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1496
Practice Address - Country:US
Practice Address - Phone:774-215-5579
Practice Address - Fax:774-215-6179
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2346929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily