Healthcare Provider Details

I. General information

NPI: 1427450857
Provider Name (Legal Business Name): RACHEL GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SCHENK ST
MADISON WI
53714-2331
US

IV. Provider business mailing address

6790 MOON LIGHT CIR
SUN PRAIRIE WI
53590-9112
US

V. Phone/Fax

Practice location:
  • Phone: 608-204-1504
  • Fax: 608-204-0539
Mailing address:
  • Phone: 608-217-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number74556
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: