Provider Demographics
NPI:1952948259
Name:CIRIELLO, THETA
Entity Type:Individual
Prefix:
First Name:THETA
Middle Name:
Last Name:CIRIELLO
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 1:407 GLENDOLA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1250
Mailing Address - Country:US
Mailing Address - Phone:703-310-8386
Mailing Address - Fax:703-310-8386
Practice Address - Street 1:407 GLENDOLA AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1250
Practice Address - Country:US
Practice Address - Phone:703-310-8386
Practice Address - Fax:703-310-8386
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH437662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty