Provider Demographics
NPI:1083479141
Name:WIER, ANGELENA GRACE
Entity Type:Individual
Prefix:
First Name:ANGELENA
Middle Name:GRACE
Last Name:WIER
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 1:437 SAINT CLAIRE ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9585
Mailing Address - Country:US
Mailing Address - Phone:937-503-2192
Mailing Address - Fax:
Practice Address - Street 1:437 SAINT CLAIRE ST APT A
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9585
Practice Address - Country:US
Practice Address - Phone:937-503-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide