Provider Demographics
NPI:1316229891
Name:HART, ANGELA CHANEL
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CHANEL
Last Name:HART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 GOLDENROD LN
Mailing Address - Street 2:
Mailing Address - City:WARNERS
Mailing Address - State:NY
Mailing Address - Zip Code:13164-9861
Mailing Address - Country:US
Mailing Address - Phone:315-560-8752
Mailing Address - Fax:
Practice Address - Street 1:184 GOLDENROD LN
Practice Address - Street 2:
Practice Address - City:WARNERS
Practice Address - State:NY
Practice Address - Zip Code:13164-9861
Practice Address - Country:US
Practice Address - Phone:315-560-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265827-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse