Provider Demographics
NPI:1972592228
Name:GALLOWAY, GLYNN WARD JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GLYNN
Middle Name:WARD
Last Name:GALLOWAY
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:MC EWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17749-0101
Mailing Address - Country:US
Mailing Address - Phone:570-713-9826
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:EVANGELICAL COMMUNITY HOSPITAL
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9314
Practice Address - Country:US
Practice Address - Phone:570-522-2928
Practice Address - Fax:570-522-4171
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN340134L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGA1400010OtherBLUE SHIELD
PAGA1400010OtherBLUE SHIELD
S51822Medicare UPIN