Provider Demographics
NPI:1942437546
Name:GALLEGOS, SAMANTHA IRENE (GNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:IRENE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:310
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-838-7711
Mailing Address - Fax:509-747-4664
Practice Address - Street 1:122 W 7TH AVE
Practice Address - Street 2:310
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2349
Practice Address - Country:US
Practice Address - Phone:509-838-7711
Practice Address - Fax:509-747-4664
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60553300363LF0000X
IDNP924A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily