Provider Demographics
NPI:1902080575
Name:GAGLIARDI, MARIE THERESA (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESA
Last Name:GAGLIARDI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2361
Mailing Address - Country:US
Mailing Address - Phone:330-421-2526
Mailing Address - Fax:
Practice Address - Street 1:6191 CARSTEN RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9197
Practice Address - Country:US
Practice Address - Phone:330-722-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-068307164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706558OtherINDEPENDENT PROVIDER #