Healthcare Provider Details

I. General information

NPI: 1295702520
Provider Name (Legal Business Name): ANGELENE HEMINGWAY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER MCHJ-PV-C
TACOMA WA
98431-0001
US

IV. Provider business mailing address

2036 PALISADE BLVD
DUPONT WA
98327-9742
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4382
  • Fax: 253-968-4389
Mailing address:
  • Phone: 253-964-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number067181
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: