Healthcare Provider Details

I. General information

NPI: 1922540384
Provider Name (Legal Business Name): ANGELA LEE GILMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LEE LITTLEWOOD RN

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 HOLTSHIRE RD.
ORANGE MA
01364
US

IV. Provider business mailing address

288 HOLTSHIRE RD.
ORANGE MA
01364
US

V. Phone/Fax

Practice location:
  • Phone: 978-855-7474
  • Fax:
Mailing address:
  • Phone: 978-855-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2300324
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: