Provider Demographics
NPI:1013208131
Name:JALLOW, RUGIATOU (LPN)
Entity Type:Individual
Prefix:
First Name:RUGIATOU
Middle Name:
Last Name:JALLOW
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 1:5608 RED CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8490
Mailing Address - Country:US
Mailing Address - Phone:614-806-6633
Mailing Address - Fax:
Practice Address - Street 1:5608 RED CARNATION DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8490
Practice Address - Country:US
Practice Address - Phone:614-806-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse