Provider Demographics
NPI:1891072443
Name:GALLAGHER, DENISE M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD STE 138S
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1244
Mailing Address - Country:US
Mailing Address - Phone:630-528-3835
Mailing Address - Fax:630-528-3837
Practice Address - Street 1:2625 BUTTERFIELD RD STE 138S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1244
Practice Address - Country:US
Practice Address - Phone:630-528-3835
Practice Address - Fax:630-528-3837
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041242874163W00000X
IL209.002501363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041242874OtherIL LICENSE