Provider Demographics
NPI:1902128754
Name:GALLAGHER GORMAN, MARY MARGARET (LVN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:GALLAGHER GORMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W HILLSDALE BLVD
Mailing Address - Street 2:APT. G
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4271
Mailing Address - Country:US
Mailing Address - Phone:650-773-9385
Mailing Address - Fax:
Practice Address - Street 1:147 W HILLSDALE BLVD
Practice Address - Street 2:APT. G
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4271
Practice Address - Country:US
Practice Address - Phone:650-773-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 205379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse