Provider Demographics
NPI:1821867615
Name:GALLION, ANDREA KAY
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:GALLION
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 1:1700 E SMITHVILLE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1010
Mailing Address - Country:US
Mailing Address - Phone:330-601-1001
Mailing Address - Fax:330-345-0001
Practice Address - Street 1:1700 E SMITHVILLE WESTERN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1010
Practice Address - Country:US
Practice Address - Phone:330-601-1001
Practice Address - Fax:330-345-0001
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109375164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse