Healthcare Provider Details

I. General information

NPI: 1770404980
Provider Name (Legal Business Name): MARY WALLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 MAPLE RD
STOW OH
44224-4635
US

IV. Provider business mailing address

2050 MAPLE RD
STOW OH
44224-4635
US

V. Phone/Fax

Practice location:
  • Phone: 330-554-8111
  • Fax:
Mailing address:
  • Phone: 330-554-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN-248146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: