Healthcare Provider Details

I. General information

NPI: 1588781025
Provider Name (Legal Business Name): ANGELNIQUE RAQUEL WASHINGTON STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 PRINCETON DR
DAYTON OH
45406-4616
US

IV. Provider business mailing address

1709 PRINCETON DR
DAYTON OH
45406-4616
US

V. Phone/Fax

Practice location:
  • Phone: 937-554-0690
  • Fax:
Mailing address:
  • Phone: 937-554-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number378563131099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: