Provider Demographics
NPI:1144496126
Name:GALLAGAN, CECELIA E (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:E
Last Name:GALLAGAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MISS
Other - First Name:CECELIA
Other - Middle Name:E
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:4139 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9034
Mailing Address - Country:US
Mailing Address - Phone:330-702-1281
Mailing Address - Fax:330-702-1287
Practice Address - Street 1:4139 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9034
Practice Address - Country:US
Practice Address - Phone:330-702-1281
Practice Address - Fax:330-702-1287
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09841363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHME1761130OtherDEA