Healthcare Provider Details

I. General information

NPI: 1821689092
Provider Name (Legal Business Name): MRS. ANGELA CASSANDRA ANGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 MAIN STREET
HUNTINGTON WV
25702
US

IV. Provider business mailing address

522 MAIN STREET
HUNTINGTON WV
25702
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-9173
  • Fax:
Mailing address:
  • Phone: 304-429-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: