Provider Demographics
NPI:1639830094
Name:GAROFALO, JEANNE A
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:GAROFALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 EDGEWOOD ST SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3101
Mailing Address - Country:US
Mailing Address - Phone:330-418-9731
Mailing Address - Fax:
Practice Address - Street 1:345 EDGEWOOD ST SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3101
Practice Address - Country:US
Practice Address - Phone:330-418-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153260.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse