MEDICARE: ANGELA JOHNSON-ANCAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	214935	LA

General Provider Information

NPI Number	:	1609644327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JOHNSON-ANCAR

Provider Business Mailing Address
First Line	:	2300 DUMAINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-3512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 DUMAINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-3512
Country	:	US
Telephone Number	:	504-373-6205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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