MEDICARE: ANGELA KATHERINE GATES DAQUILA BSN, RN

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	163W00000X	Registered Nurse	379568	NC

General Provider Information

NPI Number	:	1720810203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KATHERINE GATES DAQUILA BSN, RN

Provider Business Mailing Address
First Line	:	1109 PEACHTREE RD NW
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-2056
Country	:	US
Telephone Number	:	407-462-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 PEACHTREE RD NW
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-2056
Country	:	US
Telephone Number	:	407-462-1234
Fax Number	:

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

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	09/06/2025

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