Provider Demographics
NPI:1518707520
Name:ALTMAN, ANGEL NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:NICOLE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478A COCKRELLS RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648
Mailing Address - Country:US
Mailing Address - Phone:740-464-8336
Mailing Address - Fax:
Practice Address - Street 1:45 N PAINT ST
Practice Address - Street 2:GROUND FLOOR STORE
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-464-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse