Provider Demographics
NPI:1932374014
Name:GALLAGHER, VIRGINIA R (APRN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:R
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2903 CAPE HORN CIR
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-7159
Mailing Address - Country:US
Mailing Address - Phone:907-690-1901
Mailing Address - Fax:
Practice Address - Street 1:2903 CAPE HORN CIR
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-7159
Practice Address - Country:US
Practice Address - Phone:907-690-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK 1353363LF0000X
MSR853694363LF0000X
NE112020363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOO871814Medicaid
MS302I500254Medicare PIN