Healthcare Provider Details

I. General information

NPI: 1174559835
Provider Name (Legal Business Name): ALLISON MARY GALLOWAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON MARY VAN FLEET FNP-C

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 MANHATTAN CIR STE 204
BOULDER CO
80303-4345
US

IV. Provider business mailing address

11659 NEWTON PL
WESTMINSTER CO
80031-5129
US

V. Phone/Fax

Practice location:
  • Phone: 720-465-9272
  • Fax:
Mailing address:
  • Phone: 720-317-8445
  • Fax: 720-851-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number168144
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0004959
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number168144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: