Healthcare Provider Details

I. General information

NPI: 1417564949
Provider Name (Legal Business Name): FELICIA LYNN GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 DANE ROAD
CENTER HARBOR NH
03226
US

IV. Provider business mailing address

PO BOX 1374
CENTER HARBOR NH
03226-1374
US

V. Phone/Fax

Practice location:
  • Phone: 603-937-0297
  • Fax:
Mailing address:
  • Phone: 603-937-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: