Healthcare Provider Details

I. General information

NPI: 1144525494
Provider Name (Legal Business Name): BARBARA J. ANGELO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 W SUNSET RD
HENDERSON NV
89014-6633
US

IV. Provider business mailing address

1590 W SUNSET RD
HENDERSON NV
89014-6633
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6700
  • Fax: 702-486-0559
Mailing address:
  • Phone: 702-486-6700
  • Fax: 702-486-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN55657
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number20554
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: