Provider Demographics
NPI:1053174094
Name:ROTRUCK, ANGELA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:ROTRUCK
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 1:26780 STATE ROUTE 93
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:OH
Mailing Address - Zip Code:43824-9793
Mailing Address - Country:US
Mailing Address - Phone:740-202-2655
Mailing Address - Fax:
Practice Address - Street 1:26780 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:OH
Practice Address - Zip Code:43824-9793
Practice Address - Country:US
Practice Address - Phone:740-202-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant