Provider Demographics
NPI:1114491354
Name:LIMA-DEANGELIS, EMILY JEANNE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEANNE
Last Name:LIMA-DEANGELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 QUEENS WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1748
Mailing Address - Country:US
Mailing Address - Phone:315-569-1737
Mailing Address - Fax:
Practice Address - Street 1:19 QUEENS WAY APT 3
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1748
Practice Address - Country:US
Practice Address - Phone:315-569-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse