Provider Demographics
NPI:1629172770
Name:GALLAHER, ELIZABETH (RD/LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:GALLAHER
Suffix:
Gender:F
Credentials:RD/LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL (ATTN: MCXX-CLD-QM)
Mailing Address - Street 2:600 CAISSON HILL ROAD
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7644
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL (ATTN: MCXX-CLD-QM)
Practice Address - Street 2:600 CAISSON HILL ROAD
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5037
Practice Address - Country:US
Practice Address - Phone:785-239-7644
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered