Provider Demographics
NPI:1083738710
Name:GALEHOUSE, ANDREA L (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:GALEHOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S COURT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-4354
Mailing Address - Country:US
Mailing Address - Phone:330-722-6337
Mailing Address - Fax:330-722-0481
Practice Address - Street 1:1075 S COURT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-4354
Practice Address - Country:US
Practice Address - Phone:330-722-6337
Practice Address - Fax:330-722-0481
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant