Provider Demographics
NPI:1679264998
Name:PRIKO, ANGELA JUNE (RN NCM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JUNE
Last Name:PRIKO
Suffix:
Gender:F
Credentials:RN NCM
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Mailing Address - Street 1:15854 STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:VANLEER
Mailing Address - State:TN
Mailing Address - Zip Code:37181-6000
Mailing Address - Country:US
Mailing Address - Phone:931-627-9122
Mailing Address - Fax:270-412-6802
Practice Address - Street 1:7973 THUNDER BLVD
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5531
Practice Address - Country:US
Practice Address - Phone:270-412-6331
Practice Address - Fax:270-412-6802
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN167327163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management