Provider Demographics
NPI:1538020136
Name:GALLAGHER, BRIONNA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRIONNA
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
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 1:8363 ALPINE AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-9390
Mailing Address - Country:US
Mailing Address - Phone:218-481-5882
Mailing Address - Fax:
Practice Address - Street 1:3700 52ND ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-9637
Practice Address - Country:US
Practice Address - Phone:616-656-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704387210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily