Provider Demographics
NPI:1205619970
Name:POOLE, ANGELICA (RN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 LUKENS LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1105
Mailing Address - Country:US
Mailing Address - Phone:775-687-0882
Mailing Address - Fax:
Practice Address - Street 1:1665 OLD HOT SPRINGS RD STE 150
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0668
Practice Address - Country:US
Practice Address - Phone:775-687-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN94361163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health