Healthcare Provider Details

I. General information

NPI: 1407014780
Provider Name (Legal Business Name): ANGELA MARIE KNIGHT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 PLAZA AVE NE APT D
WARREN OH
44483-3560
US

IV. Provider business mailing address

1960 OVERLAND AVE NE
WARREN OH
44483-2809
US

V. Phone/Fax

Practice location:
  • Phone: 330-392-3941
  • Fax:
Mailing address:
  • Phone: 330-372-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 139683-M-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: