MEDICARE: DEBORA PEARSON-GALLOWAY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	576554	TX
2	163W00000X	Registered Nurse	381643-1	NY

General Provider Information

NPI Number	:	1124554118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORA PEARSON-GALLOWAY RN

Provider Business Mailing Address
First Line	:	414 ELBERT LANE UNIT A
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548
Country	:	US
Telephone Number	:	832-641-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 ELBERT LN UNIT A
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1934
Country	:	US
Telephone Number	:	832-641-2295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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