Healthcare Provider Details

I. General information

NPI: 1972023380
Provider Name (Legal Business Name): ANGELA NICOLE LEGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GRAFTON LN
BERRYVILLE VA
22611-2576
US

IV. Provider business mailing address

635 ROGERS MILL RD
STRASBURG VA
22657-5433
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002074826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: