Provider Demographics
NPI:1750630679
Name:GALLAGHER, LISA (PNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WELCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1511
Mailing Address - Country:US
Mailing Address - Phone:650-498-5480
Mailing Address - Fax:
Practice Address - Street 1:770 WELCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1511
Practice Address - Country:US
Practice Address - Phone:650-498-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274885363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics