MEDICARE: DIANA 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	3747P1801X	Personal Care Attendant	RN 9234536	FL

General Provider Information

NPI Number	:	1477800969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GALLOWAY RN

Provider Business Mailing Address
First Line	:	1394 PEBBLE RIDGE LANE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411
Country	:	US
Telephone Number	:	425-825-1602
Fax Number	:	561-514-1966

Provider Business Practice Location Address
First Line	:	1394 PEBBLE RIDGE LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6611
Country	:	US
Telephone Number	:	425-825-1602
Fax Number	:	561-514-1966

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

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/14/2012

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