Provider Demographics
NPI:1497966402
Name:ALLEN, ANGELA DAVIS (RN, ROS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAVIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN, ROS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PAULS PATH RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8381
Mailing Address - Country:US
Mailing Address - Phone:252-566-9644
Mailing Address - Fax:
Practice Address - Street 1:227 KINGOLD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68319163W00000X, 163WC1500X, 163WP0200X, 163WW0101X
246QL0900X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Not Answered246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68319OtherRN LICENSE #