Provider Demographics
NPI:1639678915
Name:LAIL, ANGELA ALLEN
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ALLEN
Last Name:LAIL
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 1:10 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-1545
Mailing Address - Country:US
Mailing Address - Phone:828-432-6485
Mailing Address - Fax:828-212-1818
Practice Address - Street 1:10 FALLS AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1545
Practice Address - Country:US
Practice Address - Phone:828-432-6485
Practice Address - Fax:828-212-1818
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$Medicaid