Provider Demographics
NPI:1083918452
Name:CHUMBON, ANGELICA N (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:N
Last Name:CHUMBON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 EMERY CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3162
Mailing Address - Country:US
Mailing Address - Phone:614-622-3024
Mailing Address - Fax:
Practice Address - Street 1:3765 EMERY CLUB WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3162
Practice Address - Country:US
Practice Address - Phone:614-622-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN125795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse