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General NPI Number Information
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NPI Number | 1093047425
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Entity Type | Organization
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Legal Business Name | KELLY ANGELL
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 5239 RANDALL HILL RD
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City | TRUXTON
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State | NY
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Zip | 13158-4208
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Country | US
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Telephone | 160-784-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 5239 RANDALL HILL RD
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City | TRUXTON
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State | NY
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Zip | 13158
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Country | US
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Telephone | 160-784-2641
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | KELLY G ANGELL
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Credential |
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Telephone | 607-842-6419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 294888-1
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License Number State | NY
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