Provider Demographics
NPI:1821026287
Name:GALLOWAY, LYNN M (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W DALE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-226-9888
Mailing Address - Fax:319-226-9889
Practice Address - Street 1:146 W DALE ST STE 201
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703
Practice Address - Country:US
Practice Address - Phone:319-226-9888
Practice Address - Fax:319-226-9889
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA000651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR80992Medicare UPIN
IAI15266Medicare PIN