Healthcare Provider Details

I. General information

NPI: 1003126764
Provider Name (Legal Business Name): KATHY ELAINE GALLAGHER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN-STANTON RD MAP2, STE 3301
NEWARK DE
19713
US

IV. Provider business mailing address

4735 OGLETOWN-STANTON RD MAP2, STE 3301
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone: 302-623-4370
  • Fax: 302-623-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000534
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: