Healthcare Provider Details

I. General information

NPI: 1093409484
Provider Name (Legal Business Name): FALLON DREE GALLAGHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

120 BRENTWOOD COMMONS WAY STE 510
BRENTWOOD TN
37027-2028
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-2000
  • Fax:
Mailing address:
  • Phone: 615-371-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number279710
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: