Provider Demographics
NPI:1427450857
Name:GALLAGHER, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6790 MOON LIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9112
Mailing Address - Country:US
Mailing Address - Phone:608-217-3440
Mailing Address - Fax:
Practice Address - Street 1:230 SCHENK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-2331
Practice Address - Country:US
Practice Address - Phone:608-204-1504
Practice Address - Fax:608-204-0539
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI74556163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12345410224Medicaid