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General NPI Number Information
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NPI Number | 1407221906
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Entity Type | Individual
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Provider Name | THERESA GALLAGHER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 4 COLUMBUS AVE
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City | BAY CITY
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State | MI
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Zip | 48708-6457
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Country | US
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Telephone | 989-393-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 4 COLUMBUS AVE
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City | BAY CITY
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State | MI
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Zip | 48708-6457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | RN188556
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2396115249
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704239694
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License Number State | MI
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