Healthcare Provider Details

I. General information

NPI: 1154643385
Provider Name (Legal Business Name): ANGELA GRAY SEALEY CNA1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10434 HICKSBORO LN
MIDDLESEX NC
27557-8105
US

IV. Provider business mailing address

10434 HICKSBORO LN
MIDDLESEX NC
27557-8105
US

V. Phone/Fax

Practice location:
  • Phone: 252-366-0324
  • Fax:
Mailing address:
  • Phone: 252-366-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number348582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: