Provider Demographics
NPI:1255999256
Name:GALLAGHER, SUSAN MAY (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAY
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 1:8515 HALE LIO ST
Mailing Address - Street 2:
Mailing Address - City:KEKAHA
Mailing Address - State:HI
Mailing Address - Zip Code:96752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8515 HALE LIO ST
Practice Address - Street 2:
Practice Address - City:KEKAHA
Practice Address - State:HI
Practice Address - Zip Code:96752
Practice Address - Country:US
Practice Address - Phone:808-634-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI62719163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool