Provider Demographics
NPI:1245004159
Name:ANGELICA NURSE DELEGATORS
Entity type:Organization
Organization Name:ANGELICA NURSE DELEGATORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN DELEGATOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-442-0159
Mailing Address - Street 1:606 CEDAR DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-7603
Mailing Address - Country:US
Mailing Address - Phone:425-442-0159
Mailing Address - Fax:
Practice Address - Street 1:606 CEDAR DR SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7603
Practice Address - Country:US
Practice Address - Phone:425-442-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty