MEDICARE: ANGELA INDORF APRN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0028236	OH

General Provider Information

NPI Number	:	1093309593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA INDORF APRN CNP

Provider Business Mailing Address
First Line	:	855 W MAPLE ST
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-7600
Country	:	US
Telephone Number	:	330-877-3616
Fax Number	:	330-877-1783

Provider Business Practice Location Address
First Line	:	855 W MAPLE ST STE 110
Second Line	:
City	:	HARTVILLE
State	:	OH
Zip	:	44632-7601
Country	:	US
Telephone Number	:	330-877-3616
Fax Number	:	330-877-1783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	11/07/2025

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