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General NPI Number Information
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NPI Number | 1750630679
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Entity Type | Individual
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Provider Name | LISA GALLAGHER PNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 770 WELCH RD SUITE 100
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City | PALO ALTO
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State | CA
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Zip | 94304-1511
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Country | US
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Telephone | 650-498-5480
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Fax |
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Provider Business Mailing Address
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Address Line | 770 WELCH RD SUITE 100
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City | PALO ALTO
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State | CA
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Zip | 94304-1511
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Country | US
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Telephone | 650-498-5480
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN2274885
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License Number State | MA
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