Provider Demographics
NPI:1619278280
Name:GALLAGHER, MEGHAN ELIZABETH (NP)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-6149
Mailing Address - Country:US
Mailing Address - Phone:808-887-6543
Mailing Address - Fax:808-887-6294
Practice Address - Street 1:64-1032 MAMALAHOA HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8441
Practice Address - Country:US
Practice Address - Phone:808-887-6543
Practice Address - Fax:808-887-6294
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262654363LP0200X
HI1957363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI795619Medicaid