Individual
MS. ANGELA M PRENDERGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
14870 GEORGETOWN ST NE, MINERVA, OH 44657-9134
(330) 862-3000
Mailing address
14870 GEORGETOWN ST NE, MINERVA, OH 44657-9134
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
501064030106
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2717500
—
OH
01
—
501064030106
STNA REGISTRATION NUMBER
OH
Enumeration date
05/04/2007
Last updated
06/03/2014
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