Provider Demographics
NPI:1417228412
Name:LEWELLING, ANGELA LORETTA (RN,PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LORETTA
Last Name:LEWELLING
Suffix:
Gender:F
Credentials:RN,PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SUGAR LOAF RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6729
Mailing Address - Country:US
Mailing Address - Phone:865-255-3945
Mailing Address - Fax:
Practice Address - Street 1:227 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3838
Practice Address - Country:US
Practice Address - Phone:865-453-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000159027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse