Provider Demographics
NPI:1629446737
Name:GALLAGHER, DEBRA MICHELLE (APNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MICHELLE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2059
Mailing Address - Country:US
Mailing Address - Phone:608-637-2101
Mailing Address - Fax:608-638-5042
Practice Address - Street 1:104 HIGH ST
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:WI
Practice Address - Zip Code:53565-1289
Practice Address - Country:US
Practice Address - Phone:608-987-2346
Practice Address - Fax:608-987-2490
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6610-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily