MEDICARE: MRS. BONNIE LYNN GALLOWAY CNM

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	367A00000X	Advanced Practice Midwife	72000123A	IN
2	176B00000X	Midwife	MW010239	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000577790	OTHER	IN	BCBS

General Provider Information

NPI Number	:	1336120096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE LYNN GALLOWAY CNM

Provider Business Mailing Address
First Line	:	3 HOSPITAL DR
Second Line	:	SUITE 312
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9362
Country	:	US
Telephone Number	:	570-523-8700
Fax Number	:	570-523-8705

Provider Business Practice Location Address
First Line	:	3 HOSPITAL DR
Second Line	:	SUITE 312
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9362
Country	:	US
Telephone Number	:	570-523-8700
Fax Number	:	570-523-8705

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/09/2014

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