Provider Demographics
NPI:1306817226
Name:GALLOWAY, AMY L (NP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:3140 W MILANO DR
Practice Address - Street 2:STE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7200
Practice Address - Country:US
Practice Address - Phone:208-887-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-549A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily