Provider Demographics
NPI:1609425446
Name:EISAMAN, ANGELA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:EISAMAN
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 1:2308 KINGS CORNERS RD E
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9720
Mailing Address - Country:US
Mailing Address - Phone:419-688-0019
Mailing Address - Fax:
Practice Address - Street 1:2308 KINGS CORNERS RD E
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-9720
Practice Address - Country:US
Practice Address - Phone:419-688-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN211366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse