Healthcare Provider Details

I. General information

NPI: 1558265900
Provider Name (Legal Business Name): ANGIELYN RELUCIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 WEST GARTON ROAD
OZARK MO
65721
US

IV. Provider business mailing address

3925 S JEFFERSON AVE APT 7
SPRINGFIELD MO
65807-5373
US

V. Phone/Fax

Practice location:
  • Phone: 417-551-9669
  • Fax: 417-444-6422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2022035536
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: