Healthcare Provider Details

I. General information

NPI: 1649521519
Provider Name (Legal Business Name): ANGLIA DAWN MEMORY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WASHINGTON TRACE RD
CALIFORNIA KY
41007-9089
US

IV. Provider business mailing address

8929 WASHINGTON TRACE RD
CALIFORNIA KY
41007-9089
US

V. Phone/Fax

Practice location:
  • Phone: 859-609-0796
  • Fax:
Mailing address:
  • Phone: 859-609-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN255770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: