Provider Demographics
NPI:1851438006
Name:GALLOWAY, GREGORY C (NP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:C
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5440 W FRANKLIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1079
Mailing Address - Country:US
Mailing Address - Phone:208-422-1555
Mailing Address - Fax:208-422-1191
Practice Address - Street 1:5440 W FRANKLIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1079
Practice Address - Country:US
Practice Address - Phone:208-422-1555
Practice Address - Fax:208-422-1191
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-244A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP05719Medicare UPIN