Provider Demographics
NPI:1467810234
Name:VENTIMIGLIA, ANGELIQUE M
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:M
Last Name:VENTIMIGLIA
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 1:12 HAY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:ME
Mailing Address - Zip Code:04449-3036
Mailing Address - Country:US
Mailing Address - Phone:207-327-2079
Mailing Address - Fax:
Practice Address - Street 1:12 HAY ROAD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:ME
Practice Address - Zip Code:04449
Practice Address - Country:US
Practice Address - Phone:207-327-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME172V00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health Worker