Provider Demographics
NPI:1710017926
Name:GALLAGHER, JOAN ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 NW JOHNSON ST APT 420
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3075
Mailing Address - Country:US
Mailing Address - Phone:971-255-1030
Mailing Address - Fax:
Practice Address - Street 1:715 SW MORRISON ST
Practice Address - Street 2:SUITE 900
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3122
Practice Address - Country:US
Practice Address - Phone:503-929-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278760Medicaid
OR137435Medicare PIN
OR278760Medicaid