Provider Demographics
NPI:1669780144
Name:COVERT, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:COVERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EASTWIND CIR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8365
Mailing Address - Country:US
Mailing Address - Phone:330-354-0783
Mailing Address - Fax:
Practice Address - Street 1:1807 42ND ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1767
Practice Address - Country:US
Practice Address - Phone:330-705-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN136192164W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse