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NPI Code Detail

MEDICARE: MR. LEON DWAYNE GALLOW FNP

MEDICARE: MR. LEON DWAYNE GALLOW FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP04992LA

General Provider Information

NPI Number : 1568554897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEON DWAYNE GALLOW FNP
Provider Business Mailing Address
First Line : 8762 HIGHWAY 182
Second Line :
City : OPELOUSAS
State : LA
Zip : 70570-5603
Country : US
Telephone Number : 337-942-2005
Fax Number :
Provider Business Practice Location Address
First Line : 8762 HIGHWAY 182
Second Line :
City : OPELOUSAS
State : LA
Zip : 70570-5603
Country : US
Telephone Number : 337-942-2005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/22/2016

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