Healthcare Provider Details

I. General information

NPI: 1487242921
Provider Name (Legal Business Name): ANGELA JOAN NEDEFF RN, BSN NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6165 MUNGER RD
DAYTON OH
45459-1145
US

IV. Provider business mailing address

6165 MUNGER RD
DAYTON OH
45459-1145
US

V. Phone/Fax

Practice location:
  • Phone: 937-672-6733
  • Fax:
Mailing address:
  • Phone: 937-672-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.212204
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: