Provider Demographics
NPI:1164839544
Name:BRATCHER, ANGELA DAWN
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:BRATCHER
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 1:613 S. VINE ST.
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667
Mailing Address - Country:US
Mailing Address - Phone:330-988-0349
Mailing Address - Fax:
Practice Address - Street 1:613 S VINE ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2033
Practice Address - Country:US
Practice Address - Phone:330-988-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0051331374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051331Medicaid