Provider Demographics
NPI:1093365348
Name:JANUARY, ANGELA D (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:JANUARY
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 1:3359 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1260
Mailing Address - Country:US
Mailing Address - Phone:419-345-2133
Mailing Address - Fax:
Practice Address - Street 1:3359 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1260
Practice Address - Country:US
Practice Address - Phone:419-345-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.172545.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse