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General NPI Number Information
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NPI Number | 1902080575
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Entity Type | Individual
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Provider Name | MARIE THERESA GAGLIARDI LPN
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 6191 CARSTEN RD
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City | MEDINA
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State | OH
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Zip | 44256-9197
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Country | US
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Telephone | 330-722-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 467 LAFAYETTE RD
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City | MEDINA
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State | OH
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Zip | 44256-2361
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Country | US
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Telephone | 330-421-2526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN-068307
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License Number State | OH
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