Provider Demographics
NPI:1033262431
Name:ANGEL, BRENDA RENE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:RENE
Last Name:ANGEL
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 1:1352 MOUNT ZWINGLI RD SE
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-9703
Mailing Address - Country:US
Mailing Address - Phone:740-569-9528
Mailing Address - Fax:740-569-4549
Practice Address - Street 1:1846 NORTHSHIRE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1567
Practice Address - Country:US
Practice Address - Phone:740-689-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415274Medicare UPIN