Provider Demographics
NPI:1265262604
Name:PICKENS, ANGELA JEAN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:PICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 FOREST GLEN RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9659
Mailing Address - Country:US
Mailing Address - Phone:234-228-3614
Mailing Address - Fax:
Practice Address - Street 1:214 FOREST GLEN RD SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-9659
Practice Address - Country:US
Practice Address - Phone:234-228-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker