Healthcare Provider Details

I. General information

NPI: 1508979394
Provider Name (Legal Business Name): ANGELA DANIELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 3RD ST. WEED ARMY COMMUNITY HOSPITAL BLDG
FORT IRWIN CA
92310
US

IV. Provider business mailing address

8629 RHINELAND DR
FORT IRWIN CA
92310-2426
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3114
  • Fax:
Mailing address:
  • Phone: 760-386-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number713876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: