Healthcare Provider Details

I. General information

NPI: 1770204448
Provider Name (Legal Business Name): SARAH MARIA GALLEGOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH MARIA TAYLOR

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 MINNEQUA AVE
PUEBLO CO
81004-3733
US

IV. Provider business mailing address

PO BOX 156
RYE CO
81069-0156
US

V. Phone/Fax

Practice location:
  • Phone: 719-557-4000
  • Fax:
Mailing address:
  • Phone: 719-289-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0997834-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0997834-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0997834-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: