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General NPI Number Information
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NPI Number | 1003790031
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE 180
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 12271 CENTER DR
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City | ORIENT
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State | OH
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Zip | 43146-9120
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Country | US
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Telephone | 220-263-6047
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Fax |
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Provider Business Mailing Address
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Address Line | 12271 CENTER DR
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City | ORIENT
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State | OH
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Zip | 43146-9120
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Country | US
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Telephone | 220-263-6047
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | ANGELA RUTH CORBETT
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Credential | CNP
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Telephone | 220-263-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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