Healthcare Provider Details

I. General information

NPI: 1174979629
Provider Name (Legal Business Name): MEGHAN ELIZABETH GALLAGHER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

1224 W ROSCOE ST APT 1
CHICAGO IL
60657-1424
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 302-379-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209014948
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: