MEDICARE: MRS. ANGELA JEAN DURIS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1578397022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA JEAN DURIS

Provider Business Mailing Address
First Line	:	2963 EDGEWOOD RD
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9711
Country	:	US
Telephone Number	:	419-349-8536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3453 FOREST GROVE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4104
Country	:	US
Telephone Number	:	567-249-9597
Fax Number	:

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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