Provider Demographics
NPI:1205032216
Name:GEIL, ANGELA DIANNE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANNE
Last Name:GEIL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13863 STATE ROUTE 278
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8694
Mailing Address - Country:US
Mailing Address - Phone:740-385-8943
Mailing Address - Fax:
Practice Address - Street 1:13863 STATE ROUTE 278
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8694
Practice Address - Country:US
Practice Address - Phone:740-385-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 364579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1205032216Medicaid