Healthcare Provider Details

I. General information

NPI: 1619278280
Provider Name (Legal Business Name): MEGHAN ELIZABETH GALLAGHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1032 MAMALAHOA HWY SUITE 204
KAMUELA HI
96743-8441
US

IV. Provider business mailing address

PO BOX 6149
KAMUELA HI
96743-6149
US

V. Phone/Fax

Practice location:
  • Phone: 808-887-6543
  • Fax: 808-887-6294
Mailing address:
  • Phone: 808-887-6543
  • Fax: 808-887-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2262654
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1957
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: