Provider Demographics
NPI:1760244057
Name:ROBERTSON, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48131 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:CALCUTTA
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9772
Mailing Address - Country:US
Mailing Address - Phone:234-736-1044
Mailing Address - Fax:
Practice Address - Street 1:48131 MOORE RD
Practice Address - Street 2:
Practice Address - City:CALCUTTA
Practice Address - State:OH
Practice Address - Zip Code:43920-9772
Practice Address - Country:US
Practice Address - Phone:234-736-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide