Healthcare Provider Details

I. General information

NPI: 1073478772
Provider Name (Legal Business Name): NICOLE MARIE GALLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 HORIZON CT STE 220
GRAND JUNCTION CO
81506-8716
US

IV. Provider business mailing address

743 HORIZON CT STE 220
GRAND JUNCTION CO
81506-8716
US

V. Phone/Fax

Practice location:
  • Phone: 970-432-3361
  • Fax:
Mailing address:
  • Phone: 970-432-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.1001476-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: