Provider Demographics
NPI:1710441670
Name:EGUZOUWA, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:EGUZOUWA
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 1:56 SCHELLER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:PA
Mailing Address - Zip Code:17560-9713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 SCHELLER RD
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:PA
Practice Address - Zip Code:17560-9713
Practice Address - Country:US
Practice Address - Phone:717-786-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN639023163WA2000X, 163WC0200X, 163WC1500X, 163WH0200X, 163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care