Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Gallus Lereh Fotabong

Individual provider Gerontology Nurse Practitioner · NPI 1821755513

Mr. Gallus Lereh Fotabong is a Gerontology Nurse Practitioner in Lynn, Massachusetts. Licensed in Massachusetts. Registered with an NPI since 2021.

Licensed in
MA
In the registry since
2021

Practice location Address checks out

41 Harvest St
Lynn, MA 01902-1122
Phone: (781) 244-8473
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence AG11210066 (MA)

Record details

NPI number1821755513
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 17, 2021
Last updated in NPPESNovember 17, 2021
Certification dateNovember 17, 2021

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