Provider Demographics
NPI:1396054540
Name:STAFFORD, ANGLEA LOUISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGLEA
Middle Name:LOUISE
Last Name:STAFFORD
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 1:367 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2433
Mailing Address - Country:US
Mailing Address - Phone:937-606-2019
Mailing Address - Fax:
Practice Address - Street 1:367 HOME AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2433
Practice Address - Country:US
Practice Address - Phone:937-606-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse