Healthcare Provider Details

I. General information

NPI: 1952023798
Provider Name (Legal Business Name): ANGELA MARIE EDWARDS D.MIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SUPERIOR AVE
DAYTON OH
45402-6308
US

IV. Provider business mailing address

717 SUPERIOR AVE
DAYTON OH
45402-6308
US

V. Phone/Fax

Practice location:
  • Phone: 937-210-9507
  • Fax: 800-883-4139
Mailing address:
  • Phone: 937-248-4047
  • Fax: 800-883-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0000307808
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: