Individual
ANGELIA DAWN SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5227
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5227
(740) 441-8058
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
36798
WV
367500000X
Certified Registered Nurse Anesthetist
4064A
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.06914-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204799
OH MEDICAID UNISON
OH
01
—
000000223446
ANTHEM BCBS
—
01
—
001714140
MOUNTAIN STATE BCBS
—
05
—
1164497178
—
WV
05
—
2240702
—
OH
05
—
2605057000
—
WV
01
—
430073754
RR MEDICARE
OH
Enumeration date
02/22/2006
Last updated
04/29/2026
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