Provider Demographics
NPI:1457620767
Name:DEGRAW, ANGELA N (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:DEGRAW
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 1:239 CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-3107
Mailing Address - Country:US
Mailing Address - Phone:315-889-4128
Mailing Address - Fax:315-889-4133
Practice Address - Street 1:239 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13160-3107
Practice Address - Country:US
Practice Address - Phone:315-889-4128
Practice Address - Fax:315-889-4133
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580760-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool