Provider Demographics
NPI:1861540353
Name:GALLAGHER, SUSAN E (CRNFA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNFA
Mailing Address - Street 1:211 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1368
Mailing Address - Country:US
Mailing Address - Phone:609-294-1660
Mailing Address - Fax:609-296-6645
Practice Address - Street 1:211 DANBURY DR
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-1368
Practice Address - Country:US
Practice Address - Phone:609-294-1660
Practice Address - Fax:609-296-6645
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06453100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse