Provider Demographics
NPI:1114336708
Name:DAIGLE, ANGEL HEATHER (RN)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:HEATHER
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MOREY RD
Mailing Address - Street 2:
Mailing Address - City:KENDUSKEAG
Mailing Address - State:ME
Mailing Address - Zip Code:04450-3031
Mailing Address - Country:US
Mailing Address - Phone:207-852-1450
Mailing Address - Fax:207-884-9024
Practice Address - Street 1:119 MOREY RD
Practice Address - Street 2:
Practice Address - City:KENDUSKEAG
Practice Address - State:ME
Practice Address - Zip Code:04450-3031
Practice Address - Country:US
Practice Address - Phone:207-852-1450
Practice Address - Fax:207-884-9024
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER053974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse