Provider Demographics
NPI:1346664299
Name:GALAN, MARIE ASHLEY (EDS)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ASHLEY
Last Name:GALAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4362
Mailing Address - Country:US
Mailing Address - Phone:513-217-2887
Mailing Address - Fax:
Practice Address - Street 1:1415 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4362
Practice Address - Country:US
Practice Address - Phone:513-217-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3158121390200000X
IL2537947390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program