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General NPI Number Information
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NPI Number | 1235840729
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Entity Type | Individual
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Provider Name | ANGELA MEDANCIC PNP
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Gender | Female
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 5603 DARROW RD STE 200
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City | HUDSON
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State | OH
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Zip | 44236-5015
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Country | US
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Telephone | 440-637-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 5603 DARROW RD STE 200
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City | HUDSON
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State | OH
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Zip | 44236-5015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | TBD
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License Number State | OH
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