Provider Demographics
NPI:1295338101
Name:VANCE, ANGELA MARIE (DSP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:VANCE
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 MOGADORE RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-7237
Mailing Address - Country:US
Mailing Address - Phone:330-208-8335
Mailing Address - Fax:
Practice Address - Street 1:5233 MOGADORE RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7237
Practice Address - Country:US
Practice Address - Phone:330-208-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6705735Medicaid