Provider Demographics
NPI:1164000493
Name:NELSON, ANGELA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:NELSON
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 1:57140 WINDING HILL RD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-8524
Mailing Address - Country:US
Mailing Address - Phone:740-359-5473
Mailing Address - Fax:
Practice Address - Street 1:67670 TRACO DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9375
Practice Address - Country:US
Practice Address - Phone:740-695-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse