Provider Demographics
NPI:1336315548
Name:PROVOST, ANGELA LOUISE (MS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:PROVOST
Suffix:
Gender:F
Credentials:MS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 BISHOPS HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2035
Mailing Address - Country:US
Mailing Address - Phone:781-585-7707
Mailing Address - Fax:
Practice Address - Street 1:363 BISHOPS HWY.
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-2035
Practice Address - Country:US
Practice Address - Phone:781-585-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist