Provider Demographics
NPI:1659332500
Name:BLACKENBERRY-ADAMS, ANGELA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:BLACKENBERRY-ADAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5270 CR 25
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9207
Mailing Address - Country:US
Mailing Address - Phone:419-768-2744
Mailing Address - Fax:419-768-2744
Practice Address - Street 1:5270 CR 25
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9207
Practice Address - Country:US
Practice Address - Phone:419-768-2744
Practice Address - Fax:419-768-2744
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108888164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse