Provider Demographics
NPI:1942663935
Name:SANDERS, ANGEL JUSTINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:JUSTINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2802
Mailing Address - Country:US
Mailing Address - Phone:330-369-8022
Mailing Address - Fax:
Practice Address - Street 1:131 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2802
Practice Address - Country:US
Practice Address - Phone:330-369-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157971-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse