MEDICARE: ANGELA HOLLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	255465	OH

General Provider Information

NPI Number	:	1255614871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA HOLLIS

Provider Business Mailing Address
First Line	:	42 GRAND BLVD
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-2148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 GRAND BLVD
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-2148
Country	:	US
Telephone Number	:	440-786-7860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “ ANGELA HOLLIS ” Practice Location

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