Provider Demographics
NPI:1962695445
Name:GALLAGHER, JACQUELINE ANN (ACNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STONY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1518
Mailing Address - Country:US
Mailing Address - Phone:716-684-9434
Mailing Address - Fax:
Practice Address - Street 1:123 STONY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-1518
Practice Address - Country:US
Practice Address - Phone:716-684-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43-430232364SA2100X
NY30-303487364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health