Provider Demographics
NPI:1770303943
Name:ANGLES, ELIANNA REANN
Entity type:Individual
Prefix:
First Name:ELIANNA
Middle Name:REANN
Last Name:ANGLES
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 1:9141 N NELSON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-9683
Mailing Address - Country:US
Mailing Address - Phone:810-360-8544
Mailing Address - Fax:
Practice Address - Street 1:PO BOX P
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-0916
Practice Address - Country:US
Practice Address - Phone:231-268-0007
Practice Address - Fax:231-525-3170
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician