Provider Demographics
NPI:1790347003
Name:DENNIS, ANGELA DENISE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:DENNIS
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 1:146 BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38647-8539
Mailing Address - Country:US
Mailing Address - Phone:901-692-4146
Mailing Address - Fax:
Practice Address - Street 1:2233 HWY 7
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MS
Practice Address - Zip Code:38642
Practice Address - Country:US
Practice Address - Phone:901-692-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care