Healthcare Provider Details

I. General information

NPI: 1518436369
Provider Name (Legal Business Name): TAMMY GALLOW RD, CD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 EMERYWOOD PKWY STE 103
RICHMOND VA
23294-3746
US

IV. Provider business mailing address

2924 EMERYWOOD PKWY STE 103
RICHMOND VA
23294-3746
US

V. Phone/Fax

Practice location:
  • Phone: 804-527-0815
  • Fax:
Mailing address:
  • Phone: 804-527-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDT85484
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number944465
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number620126
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: