Provider Demographics
NPI:1245060748
Name:GALLAGHER, KATELYN (RN)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7208
Mailing Address - Country:US
Mailing Address - Phone:707-599-8899
Mailing Address - Fax:
Practice Address - Street 1:2350 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3238
Practice Address - Country:US
Practice Address - Phone:707-443-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95341114163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory