Provider Demographics
NPI:1790541597
Name:JILES, ANGELA DIONNE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIONNE
Last Name:JILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DIONNE
Other - Last Name:PERYMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-2522
Mailing Address - Country:US
Mailing Address - Phone:937-450-0816
Mailing Address - Fax:
Practice Address - Street 1:525 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-2522
Practice Address - Country:US
Practice Address - Phone:937-450-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant