Provider Demographics
NPI:1275838468
Name:WILLIAMS, ANGELINA RENEE' (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:RENEE'
Last Name:WILLIAMS
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 1:204 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9661
Mailing Address - Country:US
Mailing Address - Phone:419-680-4301
Mailing Address - Fax:
Practice Address - Street 1:204 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-9661
Practice Address - Country:US
Practice Address - Phone:419-680-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137646164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse