Provider Demographics
NPI:1962631705
Name:BROWN, ANGELA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:BROWN
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 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT BLANCHARD
Mailing Address - State:OH
Mailing Address - Zip Code:45867-8704
Mailing Address - Country:US
Mailing Address - Phone:419-957-3003
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MT BLANCHARD
Practice Address - State:OH
Practice Address - Zip Code:45867-8704
Practice Address - Country:US
Practice Address - Phone:419-957-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.107827-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse