MEDICARE: ANGEL DENISE PEOPLES CNA

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	376K00000X	Nurse's Aide	134968	MO

General Provider Information

NPI Number	:	1699593632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL DENISE PEOPLES CNA

Provider Business Mailing Address
First Line	:	214 MISKELL BLVD # A
Second Line	:
City	:	CAHOKIA
State	:	IL
Zip	:	62206-2116
Country	:	US
Telephone Number	:	314-240-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	10016 OFFICE CENTER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1468
Country	:	US
Telephone Number	:	636-519-0881
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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