Healthcare Provider Details

I. General information

NPI: 1831551936
Provider Name (Legal Business Name): ANGELA PUTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E BALDWIN ST
BLANCHESTER OH
45107-1203
US

IV. Provider business mailing address

327 E BALDWIN ST
BLANCHESTER OH
45107-1203
US

V. Phone/Fax

Practice location:
  • Phone: 937-783-2681
  • Fax: 937-783-2229
Mailing address:
  • Phone: 937-783-2681
  • Fax: 937-783-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN209777
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: