Provider Demographics
NPI:1699005926
Name:GALLAGHER, AMANDA (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
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 1:2217 STONEWALL FARMS DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5468
Mailing Address - Country:US
Mailing Address - Phone:919-510-5919
Mailing Address - Fax:
Practice Address - Street 1:4209 LASSITER MILL RD STE 133
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5883
Practice Address - Country:US
Practice Address - Phone:919-510-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner