MEDICARE: MS. ANGELA SAMUEL YOUNGBLOOD 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	94460	SC

General Provider Information

NPI Number	:	1831411081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA SAMUEL YOUNGBLOOD RN

Provider Business Mailing Address
First Line	:	7001 SAINT ANDREWS RD # 342
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-800-4520
Fax Number	:	803-749-4305

Provider Business Practice Location Address
First Line	:	7001 SAINT ANDREWS RD # 342
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-800-4520
Fax Number	:	803-749-4305

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

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	07/12/2010

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