Provider Demographics
NPI:1720087398
Name:GALLAGHER, KATRINA (NP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S RANDALL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5937
Mailing Address - Country:US
Mailing Address - Phone:224-783-4365
Mailing Address - Fax:224-783-4356
Practice Address - Street 1:12151 REGENCY PKWY STE 12137
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7644
Practice Address - Country:US
Practice Address - Phone:847-515-2200
Practice Address - Fax:847-515-2328
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000016363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11839Medicare ID - Type UnspecifiedLOCALITY 15
ILIL2797005Medicare PIN
ILR01423Medicare PIN
IL209897Medicare ID - Type UnspecifiedGROUP LOCALITY 15
ILR01424Medicare PIN
ILP01158257Medicare PIN
ILQ24944Medicare UPIN
IL209896Medicare ID - Type UnspecifiedGROUP LOCALITY 99
ILK11838Medicare ID - Type UnspecifiedLOCALITY 99