Provider Demographics
NPI:1710704473
Name:GALYEAN, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GALYEAN
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 FOUR POLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ISABAN
Mailing Address - State:WV
Mailing Address - Zip Code:24846
Mailing Address - Country:US
Mailing Address - Phone:304-784-5631
Mailing Address - Fax:
Practice Address - Street 1:1706 FOUR POLE ROAD
Practice Address - Street 2:
Practice Address - City:ISABAN
Practice Address - State:WV
Practice Address - Zip Code:24846
Practice Address - Country:US
Practice Address - Phone:304-784-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty