Provider Demographics
NPI:1871041178
Name:ZAKLAN, ANGIE LOREEN
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:LOREEN
Last Name:ZAKLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:LOREEN
Other - Last Name:HILVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15419 AVENUE 96
Mailing Address - Street 2:
Mailing Address - City:PIXLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93256-9730
Mailing Address - Country:US
Mailing Address - Phone:559-901-8513
Mailing Address - Fax:
Practice Address - Street 1:15419 AVENUE 96
Practice Address - Street 2:
Practice Address - City:PIXLEY
Practice Address - State:CA
Practice Address - Zip Code:93256-9730
Practice Address - Country:US
Practice Address - Phone:559-901-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN684743164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse