Provider Demographics
NPI:1871180539
Name:GALLAWAY, JENNIFER LEAH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEAH
Last Name:GALLAWAY
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 1:3893 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:OH
Mailing Address - Zip Code:44843-9716
Mailing Address - Country:US
Mailing Address - Phone:419-565-5325
Mailing Address - Fax:
Practice Address - Street 1:3893 STATE ROUTE 39
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:OH
Practice Address - Zip Code:44843-9716
Practice Address - Country:US
Practice Address - Phone:419-565-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide