Provider Demographics
NPI:1093047425
Name:KELLY ANGELL
Entity Type:Organization
Organization Name:KELLY ANGELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-842-6419
Mailing Address - Street 1:5239 RANDALL HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRUXTON
Mailing Address - State:NY
Mailing Address - Zip Code:13158
Mailing Address - Country:US
Mailing Address - Phone:160-784-2641
Mailing Address - Fax:
Practice Address - Street 1:5239 RANDALL HILL RD
Practice Address - Street 2:
Practice Address - City:TRUXTON
Practice Address - State:NY
Practice Address - Zip Code:13158-4208
Practice Address - Country:US
Practice Address - Phone:160-784-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294888-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care