Provider Demographics
NPI:1649745621
Name:DAVIS, ANGELA (NURSE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3221 KELLER SPRINGS RD APT 2201
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5144
Mailing Address - Country:US
Mailing Address - Phone:318-348-6747
Mailing Address - Fax:
Practice Address - Street 1:3221 KELLER SPRINGS RD APT 2201
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5144
Practice Address - Country:US
Practice Address - Phone:318-348-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX833497163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency