Provider Demographics
NPI:1225895345
Name:IVES, ANGELA R (CPRS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:IVES
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E SHOREWAY DR APT A
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4437
Mailing Address - Country:US
Mailing Address - Phone:567-901-4437
Mailing Address - Fax:
Practice Address - Street 1:1805 E SHOREWAY DR APT A
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4437
Practice Address - Country:US
Practice Address - Phone:567-901-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist