Provider Demographics
NPI:1891755385
Name:STALDER, ANGELA K (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:STALDER
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 1:1717 FOLK REAM RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9151
Mailing Address - Country:US
Mailing Address - Phone:937-882-6402
Mailing Address - Fax:937-882-6402
Practice Address - Street 1:1717 FOLK REAM RD
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-9151
Practice Address - Country:US
Practice Address - Phone:937-882-6402
Practice Address - Fax:937-882-6402
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN252769163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2531031Medicaid