Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN.CNP.021218 | OH |
NPI | 1053833079 |
---|---|
Provider Name | Mrs. Angela Marie Perciak |
First Address | Richfield, OH 44286-9168 |
Second Address | Akron, OH 44313-7129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 11/07/2017 |