Healthcare Provider Details

I. General information

NPI: 1396564985
Provider Name (Legal Business Name): ANGELA KLIMKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7341 EISENHOWER DR
BOARDMAN OH
44512-5900
US

IV. Provider business mailing address

4645 BUNNY TRL
CANFIELD OH
44406-9388
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-1138
  • Fax: 330-726-6128
Mailing address:
  • Phone: 330-502-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: