Provider Demographics
NPI:1710488093
Name:THOMAS, ANGELA DENISE (CNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6045
Mailing Address - Country:US
Mailing Address - Phone:804-937-7612
Mailing Address - Fax:
Practice Address - Street 1:302 S 13TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6045
Practice Address - Country:US
Practice Address - Phone:804-937-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401187441376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide