1609897883 NPI number — CHERYL ADELINE GALEGHER ROSS NP

Table of content: CHERYL ADELINE GALEGHER ROSS NP (NPI 1609897883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609897883 NPI number — CHERYL ADELINE GALEGHER ROSS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALEGHER ROSS
Provider First Name:
CHERYL
Provider Middle Name:
ADELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALEGHER
Provider Other First Name:
CHERYL
Provider Other Middle Name:
ADELINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609897883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3118 9TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58102-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-280-2486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-4820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-864-5128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R23332 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0280827-22 . This is a "ANCC BOARD CERTIFICATION" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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