Provider Demographics
NPI:1871368068
Name:ANGELO, KRISTEN E
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:ANGELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 E 328TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3311
Mailing Address - Country:US
Mailing Address - Phone:440-488-1062
Mailing Address - Fax:
Practice Address - Street 1:30131 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1854
Practice Address - Country:US
Practice Address - Phone:440-488-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide