MEDICARE: ANGEL NICOLE DRAKE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	128851	OH

General Provider Information

NPI Number	:	1699081505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL NICOLE DRAKE LPN

Provider Business Mailing Address
First Line	:	5716 7 GABLES AVE
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2114
Country	:	US
Telephone Number	:	937-837-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	5716 7 GABLES AVE
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2114
Country	:	US
Telephone Number	:	937-837-8820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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