Healthcare Provider Details

I. General information

NPI: 1093309593
Provider Name (Legal Business Name): ANGELA INDORF APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA PLAVKA

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W MAPLE ST STE 110
HARTVILLE OH
44632-7601
US

IV. Provider business mailing address

855 W MAPLE ST
HARTVILLE OH
44632-7600
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-3616
  • Fax: 330-877-1783
Mailing address:
  • Phone: 330-877-3616
  • Fax: 330-877-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0028236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: