Provider Demographics
NPI:1346856093
Name:SMITH, ANGELA GAYLE (PHLEBOTOMIST TECH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GAYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHLEBOTOMIST TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ORCHARD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107
Mailing Address - Country:US
Mailing Address - Phone:513-560-0584
Mailing Address - Fax:
Practice Address - Street 1:1172 W GALBRAITH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-202-3729
Practice Address - Fax:513-541-2198
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy