Basic Information
| Provider Information | |||||||||
| NPI: | 1336120096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLOWAY | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 HOSPITAL DR | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705238700 | ||||||||
| FaxNumber: | 5705238705 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 HOSPITAL DR | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705238700 | ||||||||
| FaxNumber: | 5705238705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 72000123A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | MW010239 | PA | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 200857240 | 05 | IN | MEDICAID | 4088840-10 | 05 | MI | MEDICAID | 000000577790 | 01 | IN | BCBS | OTHER |