Provider Demographics
NPI:1013564913
Name:POLEY, ANGELA M (LVN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:POLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WURZBACH RD STE 700
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4332
Mailing Address - Country:US
Mailing Address - Phone:310-737-8090
Mailing Address - Fax:
Practice Address - Street 1:114 VALENCIA
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3112
Practice Address - Country:US
Practice Address - Phone:830-515-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328109164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29509977Medicaid