Provider Demographics
NPI:1508044470
Name:WILLS-GALLAGHER, JENNIFER LEIGH (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:WILLS-GALLAGHER
Suffix:
Gender:F
Credentials:RD, LDN
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Other - Credentials:
Mailing Address - Street 1:211 FRIDAY CENTER DR
Mailing Address - Street 2:HEDRICK BUILDING SUITE 2091, ROOM 2094
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9499
Mailing Address - Country:US
Mailing Address - Phone:984-974-1186
Mailing Address - Fax:984-974-1311
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:OUTPATIENT CLINICAL NUTRITION DEPARTMENT
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCL002946133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ48412AMedicare UPIN