Healthcare Provider Details

I. General information

NPI: 1497079834
Provider Name (Legal Business Name): ANGELA LEE GULLEY R,N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 WATERVLIET AVE
DAYTON OH
45420-2705
US

IV. Provider business mailing address

1217 WATERVLIET AVE
DAYTON OH
45420-2705
US

V. Phone/Fax

Practice location:
  • Phone: 937-684-3645
  • Fax:
Mailing address:
  • Phone: 937-684-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number265254
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number265254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: