Individual
ALYSSA MARIE GALLAGHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Mailing address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-633
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730497991
—
ID
01
—
D-633
D-633
ID
Enumeration date
09/21/2010
Last updated
03/21/2016
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