Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350356 | NY |
NPI | 1053723858 |
---|---|
Provider Name | Jillian Gallagher |
First Address | Bronx, NY 10457-7606 |
Second Address | Bronx, NY 10457-7606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 28/05/2014 |