Provider Demographics
NPI:1285054726
Name:GALLOWAY, JEAN
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:D
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1705 W EVANS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3331
Mailing Address - Country:US
Mailing Address - Phone:843-661-4762
Mailing Address - Fax:843-661-4774
Practice Address - Street 1:1705 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3331
Practice Address - Country:US
Practice Address - Phone:843-661-4762
Practice Address - Fax:843-661-4774
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24577163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse