Provider Demographics
NPI:1417334301
Name:GALLAGHER, PATRICIA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 ASTOR AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5847
Mailing Address - Country:US
Mailing Address - Phone:347-449-6414
Mailing Address - Fax:
Practice Address - Street 1:1466 ASTOR AVE
Practice Address - Street 2:APT 3R
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5847
Practice Address - Country:US
Practice Address - Phone:347-449-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290764164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse