Provider Demographics
NPI:1619090511
Name:DUHL, ANGELA KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:DUHL
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 1:183 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1558
Mailing Address - Country:US
Mailing Address - Phone:740-288-4108
Mailing Address - Fax:
Practice Address - Street 1:183 CROSS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1558
Practice Address - Country:US
Practice Address - Phone:740-288-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104189164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2229387Medicaid