Provider Demographics
NPI:1679350219
Name:RADONSKI, ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RADONSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:KELLEY DYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:3594 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-3001
Mailing Address - Country:US
Mailing Address - Phone:503-396-3663
Mailing Address - Fax:
Practice Address - Street 1:3594 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3001
Practice Address - Country:US
Practice Address - Phone:503-396-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60275497163WS0200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WS0200XNursing Service ProvidersRegistered NurseSchool