Provider Demographics
NPI:1386430668
Name:GALLAHER, MACYBELEN PALISOC (FNP-BC)
Entity type:Individual
Prefix:
First Name:MACYBELEN
Middle Name:PALISOC
Last Name:GALLAHER
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ROARING COUGAR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1616
Mailing Address - Country:US
Mailing Address - Phone:707-853-6634
Mailing Address - Fax:
Practice Address - Street 1:98 ANETO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6349
Practice Address - Country:US
Practice Address - Phone:702-202-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV887288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily