Provider Demographics
NPI:1578979928
Name:GALLAGHER, HEATHER (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GALLAGHER
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 1:1246 BRISCOE RD
Mailing Address - Street 2:
Mailing Address - City:SWAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12783-6900
Mailing Address - Country:US
Mailing Address - Phone:845-629-4989
Mailing Address - Fax:
Practice Address - Street 1:1246 BRISCOE RD
Practice Address - Street 2:
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783-6900
Practice Address - Country:US
Practice Address - Phone:845-629-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662996163WG0000X, 163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics