Healthcare Provider Details

I. General information

NPI: 1841522505
Provider Name (Legal Business Name): ANGELA M DAMORE BN, RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W CRESCENT PARK FL 2
WARREN PA
16365-2111
US

IV. Provider business mailing address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-723-0407
  • Fax: 814-726-9412
Mailing address:
  • Phone: 814-723-0407
  • Fax: 814-726-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number582468
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341177-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016927
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: