Provider Demographics
NPI:1538758917
Name:ANKROM, CONNIE SUE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:ANKROM
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 1:34185 MILTONSBURG CALAIS RD
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-9213
Mailing Address - Country:US
Mailing Address - Phone:740-213-8427
Mailing Address - Fax:
Practice Address - Street 1:34185 MILTONSBURG CALAIS RD
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-9213
Practice Address - Country:US
Practice Address - Phone:740-213-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000000000Medicaid