Provider Demographics
NPI:1194426668
Name:MIRANDA, ANGELINE
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 REEVES RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4332
Mailing Address - Country:US
Mailing Address - Phone:330-372-2010
Mailing Address - Fax:
Practice Address - Street 1:2282 REEVES RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4300
Practice Address - Country:US
Practice Address - Phone:330-372-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator