Healthcare Provider Details

I. General information

NPI: 1629446737
Provider Name (Legal Business Name): DEBRA MICHELLE GALLAGHER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HIGH ST
MINERAL POINT WI
53565-1289
US

IV. Provider business mailing address

507 S MAIN ST
VIROQUA WI
54665-2059
US

V. Phone/Fax

Practice location:
  • Phone: 608-987-2346
  • Fax: 608-987-2490
Mailing address:
  • Phone: 608-637-2101
  • Fax: 608-638-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6610-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: