Healthcare Provider Details

I. General information

NPI: 1568237774
Provider Name (Legal Business Name): ANGELA WHIPPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA WHIPPLE CEO

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5227 HINDEL LN
CANAL WINCHESTER OH
43110
US

IV. Provider business mailing address

5227 HINDEL LN
CANAL WINCHESTER OH
43110
US

V. Phone/Fax

Practice location:
  • Phone: 614-512-2336
  • Fax:
Mailing address:
  • Phone: 614-512-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: