MEDICARE: REBECCA GALLAGHER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71002106A	IN

General Provider Information

NPI Number	:	1083623490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GALLAGHER NP

Provider Business Mailing Address
First Line	:	3700 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47750-0001
Country	:	US
Telephone Number	:	812-485-5800
Fax Number	:	812-485-5422

Provider Business Practice Location Address
First Line	:	1146 WASHINGTON SQ
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-6809
Country	:	US
Telephone Number	:	812-485-5800
Fax Number	:	812-485-5422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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