Provider Demographics
NPI:1750610929
Name:GALLOWAY, SERENA D (CLD)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:D
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:MRS
Other - First Name:SERENA
Other - Middle Name:D
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLD
Mailing Address - Street 1:271 AUDUBON BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2640
Mailing Address - Country:US
Mailing Address - Phone:970-402-4228
Mailing Address - Fax:
Practice Address - Street 1:271 AUDUBON BLVD
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-2640
Practice Address - Country:US
Practice Address - Phone:970-402-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula