Provider Demographics
NPI:1104422146
Name:FITTS, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:FITTS
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 1:15 MEADOWVIEW CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1728
Mailing Address - Country:US
Mailing Address - Phone:937-626-1813
Mailing Address - Fax:
Practice Address - Street 1:15 MEADOWVIEW CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1728
Practice Address - Country:US
Practice Address - Phone:937-626-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83045893747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant