Healthcare Provider Details

I. General information

NPI: 1164419099
Provider Name (Legal Business Name): ANGELINE CLAIRE STIKELEATHER C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DR MAY-GRANT ASSOCIATES
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

839 FOUNTAIN AVE
LANCASTER PA
17601-4532
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-8177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberMW008371L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: