Individual
ANGELLA ANNETTE KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
1007 ACADEMY CT, PAINESVILLE, OH 44077-2705
(440) 279-8416
Mailing address
1007 ACADEMY CT, PAINESVILLE, OH 44077-2705
(440) 279-8416
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401562690813
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109204
MEDICAID PROVIDER NUMBER
OH
Enumeration date
09/24/2014
Last updated
09/24/2014
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