Provider Demographics
NPI:1003790031
Name:ABUNDANT LIFE 180
Entity type:Organization
Organization Name:ABUNDANT LIFE 180
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:220-263-6047
Mailing Address - Street 1:12271 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9120
Mailing Address - Country:US
Mailing Address - Phone:220-263-6047
Mailing Address - Fax:
Practice Address - Street 1:12271 CENTER DR
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9120
Practice Address - Country:US
Practice Address - Phone:220-263-6047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty