Provider Demographics
NPI:1619009149
Name:PEREZ, ANGELA ELAINE (STNA, HHA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:ELAINE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:STNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N LOCKWOOD AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2354
Mailing Address - Country:US
Mailing Address - Phone:419-509-4560
Mailing Address - Fax:419-478-8226
Practice Address - Street 1:4541 N LOCKWOOD AVE UPPR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2354
Practice Address - Country:US
Practice Address - Phone:419-509-4560
Practice Address - Fax:419-478-8226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400183141102374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide