Provider Demographics
NPI:1811269913
Name:GALLAGHER, KATHRYN ANN (28130-031)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:28130-031
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3515
Mailing Address - Country:US
Mailing Address - Phone:698-754-4621
Mailing Address - Fax:
Practice Address - Street 1:329 N PINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3515
Practice Address - Country:US
Practice Address - Phone:698-754-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28130031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse