Provider Demographics
NPI:1669112918
Name:GULLEY, ANGELA FAITH
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAITH
Last Name:GULLEY
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 1:754 OLD STATE ROUTE 74 STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1275
Mailing Address - Country:US
Mailing Address - Phone:513-498-4195
Mailing Address - Fax:
Practice Address - Street 1:754 OLD STATE ROUTE 74 STE C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1275
Practice Address - Country:US
Practice Address - Phone:513-498-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management