Healthcare Provider Details

I. General information

NPI: 1063435683
Provider Name (Legal Business Name): LESLIE GALLAGHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311-4E JUDGES ROAD
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

P.O. BOX 696
HAMPSTEAD NC
28443-0696
US

V. Phone/Fax

Practice location:
  • Phone: 415-899-9800
  • Fax: 415-899-9805
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-791-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11529
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number600013
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number600013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: