MEDICARE: ANDREA MAE GALLAGHER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.304614	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0028359	OH

General Provider Information

NPI Number	:	1629669213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MAE GALLAGHER FNP

Provider Business Mailing Address
First Line	:	1524 W SANDUSKY ST
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-1728
Country	:	US
Telephone Number	:	419-722-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 CHAPEL DR STE C
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-1344
Country	:	US
Telephone Number	:	419-429-7637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	02/05/2021

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