Individual
GARY A WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
6503 MARSOL RD, APT 347, MAYFIELD HTS, OH 44124-3568
(216) 816-6160
Mailing address
6503 MARSOL RD, APT 347, MAYFIELD HEIGHTS, OH 44124-3568
(216) 373-1459
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.154227-M-IV
OH
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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