Healthcare Provider Details

I. General information

NPI: 1467059592
Provider Name (Legal Business Name): ERIN SANDY GALLAGHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRICKHILL AVE STE 201
SOUTH PORTLAND ME
04106-1999
US

IV. Provider business mailing address

100 BRICKHILL AVE STE 201
SOUTH PORTLAND ME
04106-1999
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-1728
  • Fax: 207-773-8153
Mailing address:
  • Phone: 207-773-1728
  • Fax: 207-773-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201154
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: