Healthcare Provider Details

I. General information

NPI: 1497184733
Provider Name (Legal Business Name): ANGELA UNDERWOOD STNA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NORTHLAND BLVD STE 103B
CINCINNATI OH
45246-0007
US

IV. Provider business mailing address

230 NORTHLAND BLVD STE 103B
CINCINNATI OH
45246-0007
US

V. Phone/Fax

Practice location:
  • Phone: 513-400-7150
  • Fax:
Mailing address:
  • Phone: 513-400-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400794740808
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.023467
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: