Provider Demographics
NPI:1437746047
Name:MASSIE-KOWALAK, GWENDLEON
Entity type:Individual
Prefix:
First Name:GWENDLEON
Middle Name:
Last Name:MASSIE-KOWALAK
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 1:511 MARY ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-2235
Mailing Address - Country:US
Mailing Address - Phone:740-360-9360
Mailing Address - Fax:
Practice Address - Street 1:726 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7807
Practice Address - Country:US
Practice Address - Phone:740-262-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care