Healthcare Provider Details

I. General information

NPI: 1245060748
Provider Name (Legal Business Name): KATELYN GALLAGHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST
EUREKA CA
95501-3238
US

IV. Provider business mailing address

7095 VISTA RD
EUREKA CA
95503-7208
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4666
  • Fax:
Mailing address:
  • Phone: 707-599-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95341114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: