Provider Demographics
NPI:1679205009
Name:GALLOWAY, JENNIFER ERIN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MAGNOLIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4059
Mailing Address - Country:US
Mailing Address - Phone:307-267-3298
Mailing Address - Fax:
Practice Address - Street 1:234 E 1ST ST STE 17
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2516
Practice Address - Country:US
Practice Address - Phone:307-333-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY51869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily