Provider Demographics
NPI:1841385176
Name:GALLAGHER, WENDY A (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42524 W MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239
Mailing Address - Country:US
Mailing Address - Phone:520-568-6944
Mailing Address - Fax:520-568-6985
Practice Address - Street 1:21300 N. JOHN WAYNE PARKWAY
Practice Address - Street 2:SUITE 112
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239
Practice Address - Country:US
Practice Address - Phone:520-381-3811
Practice Address - Fax:520-381-3816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily