Individual
ANGELA SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3567 RESERVE COMMONS DR STE 100, MEDINA, OH 44256-5344
(330) 664-9250
Mailing address
3567 RESERVE COMMONS DR STE 100, MEDINA, OH 44256-5344
(330) 664-9250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
398808
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0034233
OH
Other
Enumeration date
03/20/2023
Last updated
06/26/2023
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