Provider Demographics
NPI:1871954453
Name:STOUT, ANGELICA JOY (RN)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:JOY
Last Name:STOUT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 BRIAR PATCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138
Mailing Address - Country:US
Mailing Address - Phone:440-731-2866
Mailing Address - Fax:
Practice Address - Street 1:24100 BRIAR PATCH DR
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-3257
Practice Address - Country:US
Practice Address - Phone:440-731-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN385290163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool