Provider Demographics
NPI:1700183258
Name:PROEHL, ANGELA SUE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:PROEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:DREITZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 OVERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:OH
Mailing Address - Zip Code:45628-9760
Mailing Address - Country:US
Mailing Address - Phone:740-998-4995
Mailing Address - Fax:
Practice Address - Street 1:541 OVERLAKE DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:OH
Practice Address - Zip Code:45628-9760
Practice Address - Country:US
Practice Address - Phone:740-998-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 140705164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse