Healthcare Provider Details

I. General information

NPI: 1417424805
Provider Name (Legal Business Name): GERALD ALLEN CALLOWAY CERTIFIED NURSING AD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 14TH AVE S
SEATTLE WA
98168-1689
US

IV. Provider business mailing address

3405 S 176TH ST APT 231
SEATAC WA
98188-4087
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-1086
  • Fax:
Mailing address:
  • Phone: 206-852-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC10002879
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: