Provider Demographics
NPI:1205252137
Name:MCKELLOP, ANGELA (RN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:MCKELLOP
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 1:409 JOYCE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1216
Mailing Address - Country:US
Mailing Address - Phone:513-934-5855
Mailing Address - Fax:
Practice Address - Street 1:409 JOYCE CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1216
Practice Address - Country:US
Practice Address - Phone:513-934-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH286040163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool