Healthcare Provider Details

I. General information

NPI: 1013560176
Provider Name (Legal Business Name): CHRISTINE E GALLAGHER MS, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

191 K ST UNIT 5
SOUTH BOSTON MA
02127-1583
US

V. Phone/Fax

Practice location:
  • Phone: 720-207-4198
  • Fax:
Mailing address:
  • Phone: 720-207-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number003871
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number189727
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number189727
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: