Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 600013 | NC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 11529 | CA |
NPI | 1063435683 |
---|---|
Provider Name | Leslie Gallagher |
First Address | Hampstead, NC 28443-0696 |
Second Address | Wilmington, NC 28405-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7000774 | (05) | NC |
NP0115290 | (05) | CA |
R40811 | (02) | CA |