Healthcare Provider Details

I. General information

NPI: 1144057514
Provider Name (Legal Business Name): SARAH A ANGELO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 OLD CAVALRY RD
BOX ELDER SD
57719-7504
US

IV. Provider business mailing address

721 OLD CAVALRY RD
BOX ELDER SD
57719-7504
US

V. Phone/Fax

Practice location:
  • Phone: 605-381-3578
  • Fax:
Mailing address:
  • Phone: 605-381-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR043807
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: