Provider Demographics
NPI:1013495076
Name:HARRISON, ANGELIKA JENNIE (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELIKA
Middle Name:JENNIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 ROUTE 284
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3445
Mailing Address - Country:US
Mailing Address - Phone:845-820-8845
Mailing Address - Fax:
Practice Address - Street 1:686 ROUTE 284
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-3445
Practice Address - Country:US
Practice Address - Phone:845-820-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332654164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse