Provider Demographics
NPI:1528196896
Name:GALLAGHER, ERIN DEVINE (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DEVINE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:SUZANNE
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:706-650-0705
Mailing Address - Fax:706-955-0735
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-3867
Practice Address - Fax:215-829-5567
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN527069L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered