Individual
ANGELA NICOLE MYRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1117 EUCLID AVE, LORAIN, OH 44052-2703
(440) 752-9806
Mailing address
1117 EUCLID AVE, LORAIN, OH 44052-2703
(440) 752-9806
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
001030
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175T00000X
—
OH
Enumeration date
04/05/2019
Last updated
04/05/2019
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