Provider Demographics
NPI:1558692061
Name:GALLAHER, MONICA (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GALLAHER LN
Mailing Address - Street 2:
Mailing Address - City:CLARKRANGE
Mailing Address - State:TN
Mailing Address - Zip Code:38553-5361
Mailing Address - Country:US
Mailing Address - Phone:931-863-4561
Mailing Address - Fax:
Practice Address - Street 1:701 COUNTY SERVICES DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4338
Practice Address - Country:US
Practice Address - Phone:931-528-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000115360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse