Provider Demographics
NPI:1558848259
Name:LITTLE ANGELS HEALTHCARE CENTER PLLC
Entity Type:Organization
Organization Name:LITTLE ANGELS HEALTHCARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:469-857-5439
Mailing Address - Street 1:2700 W PLEASANT RUN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1074
Mailing Address - Country:US
Mailing Address - Phone:469-857-5439
Mailing Address - Fax:469-857-5444
Practice Address - Street 1:2700 W PLEASANT RUN RD STE 300
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1074
Practice Address - Country:US
Practice Address - Phone:469-857-5439
Practice Address - Fax:469-857-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X, 2080A0000X
TXAP133030363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3692956Medicaid