Healthcare Provider Details

I. General information

NPI: 1083703326
Provider Name (Legal Business Name): PATRICIA GALLAGHER CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OLD MILITARY RD
LAKE PLACID NY
12946-1738
US

IV. Provider business mailing address

229 WHITEFACE MEMORIAL HWY
WILMINGTON NY
12997-1909
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-1327
  • Fax: 518-523-9964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number389483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: