Provider Demographics
NPI:1083223713
Name:PINSON, ANGELA JO (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:PINSON
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-1416
Mailing Address - Country:US
Mailing Address - Phone:740-395-7198
Mailing Address - Fax:
Practice Address - Street 1:508 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1416
Practice Address - Country:US
Practice Address - Phone:740-395-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4064950Medicaid