Provider Demographics
NPI:1326550823
Name:ARNOLD, ANGELA (BSN RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SANTA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9700
Mailing Address - Country:US
Mailing Address - Phone:505-999-9727
Mailing Address - Fax:
Practice Address - Street 1:2422 E. HIGHWAY 333
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-8703
Practice Address - Country:US
Practice Address - Phone:505-832-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR59678163W00000X
NM356165163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse