Provider Demographics
NPI:1255731915
Name:GAROFALO, MARY DUNNING
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:DUNNING
Last Name:GAROFALO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:DUNNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:100 MILLS RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4633
Mailing Address - Country:US
Mailing Address - Phone:707-628-3009
Mailing Address - Fax:
Practice Address - Street 1:100 MILLS RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4633
Practice Address - Country:US
Practice Address - Phone:707-628-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4420363LF0000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health