Provider Demographics
NPI:1225741093
Name:WILSON, ANGELA CELESTINE
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:CELESTINE
Last Name:WILSON
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 1:3795 ATLANTIC AVE APT 48
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-4650
Mailing Address - Country:US
Mailing Address - Phone:760-508-8385
Mailing Address - Fax:
Practice Address - Street 1:3795 ATLANTIC AVE APT 48
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-4650
Practice Address - Country:US
Practice Address - Phone:760-508-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider