Healthcare Provider Details

I. General information

NPI: 1881491884
Provider Name (Legal Business Name): ANGIE LAYNE CICCARELLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE MCBRIDE LAYNE

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 PEAKS VIEW DR
MONETA VA
24121-2566
US

IV. Provider business mailing address

42 PEAKS VIEW DR
MONETA VA
24121-2566
US

V. Phone/Fax

Practice location:
  • Phone: 540-243-4407
  • Fax:
Mailing address:
  • Phone: 540-243-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001254640
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0001254640
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001254640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: