Provider Demographics
NPI:1871863076
Name:BRONZIE, ANGELA (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRONZIE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-1709
Mailing Address - Country:US
Mailing Address - Phone:513-238-8899
Mailing Address - Fax:
Practice Address - Street 1:1613 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-1709
Practice Address - Country:US
Practice Address - Phone:513-238-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001971363A00000X
OHA-1146730
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant