Provider Demographics
NPI:1700266400
Name:DENOBLE, ANGELA M (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:DENOBLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 REED ROAD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-884-0641
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED ROAD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-884-0641
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA17390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134013Medicaid
OHP01489081OtherRAILROAD MEDICARE
OHP01489081OtherRAILROAD MEDICARE