Provider Demographics
NPI:1659973543
Name:CORWIN GALLORO, MARIE KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:KATHLEEN
Last Name:CORWIN GALLORO
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 1:326 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2130
Mailing Address - Country:US
Mailing Address - Phone:419-509-1125
Mailing Address - Fax:
Practice Address - Street 1:326 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2130
Practice Address - Country:US
Practice Address - Phone:419-509-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician