=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619299468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELIQUE SUZZANNE VELNA LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2010
-----------------------------------------------------
Last Update Date | 02/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 BRENTWOOD DR
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-840-7093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 BRENTWOOD DR
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-840-7093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 125289 IV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------