Provider Demographics
NPI:1588216238
Name:WROLSTAD, ANGELA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:WROLSTAD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:BARBARA
Other - Last Name:DAMIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:614 DARBY ROAD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-804-0336
Mailing Address - Fax:610-766-7205
Practice Address - Street 1:614 DARBY ROAD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-804-0336
Practice Address - Fax:610-766-7205
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN239250L163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health