Provider Demographics
NPI:1053178327
Name:PUTNAM, ANGEL DAWN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAWN
Last Name:PUTNAM
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 1:23 SENIOR CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9581
Mailing Address - Country:US
Mailing Address - Phone:304-765-4090
Mailing Address - Fax:
Practice Address - Street 1:23 SENIOR CENTER DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9581
Practice Address - Country:US
Practice Address - Phone:304-765-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant