Provider Demographics
NPI:1356676589
Name:TRUMBLE-SITES, ANGELA MARIE (NURSE)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:TRUMBLE-SITES
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:TRUMBLE-SITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:120 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1283
Mailing Address - Country:US
Mailing Address - Phone:740-360-6954
Mailing Address - Fax:
Practice Address - Street 1:120 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1283
Practice Address - Country:US
Practice Address - Phone:740-360-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1356676589OtherNPPE