Provider Demographics
NPI:1750684312
Name:BURNS, ANGELA MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:BURNS
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 1:451 N BON AIR AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1808
Mailing Address - Country:US
Mailing Address - Phone:330-406-1047
Mailing Address - Fax:330-799-1659
Practice Address - Street 1:451 N BON AIR AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1808
Practice Address - Country:US
Practice Address - Phone:330-406-1047
Practice Address - Fax:330-799-1659
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3117639Medicaid