Healthcare Provider Details

I. General information

NPI: 1821026287
Provider Name (Legal Business Name): LYNN M GALLOWAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST STE 201
WATERLOO IA
50703
US

IV. Provider business mailing address

146 W DALE ST STE 201
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-226-9888
  • Fax: 319-226-9889
Mailing address:
  • Phone: 319-226-9888
  • Fax: 319-226-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000651
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: