Healthcare Provider Details

I. General information

NPI: 1467976381
Provider Name (Legal Business Name): RICHARD WILLIAM GALLAGHER AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENOSBURG HEALTH CENTER, 382 MAIN STREET
ENOSBURG FALLS VT
05450
US

IV. Provider business mailing address

331 AUTUMN POND WAY UNIT 105
ESSEX JUNCTION VT
05452-4080
US

V. Phone/Fax

Practice location:
  • Phone: 802-933-5831
  • Fax: 802-933-5836
Mailing address:
  • Phone: 603-727-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0132405
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: