Provider Demographics
NPI:1649521519
Name:MEMORY, ANGLIA DAWN (RN)
Entity type:Individual
Prefix:MRS
First Name:ANGLIA
Middle Name:DAWN
Last Name:MEMORY
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 1:8929 WASHINGTON TRACE RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-9089
Mailing Address - Country:US
Mailing Address - Phone:859-609-0796
Mailing Address - Fax:
Practice Address - Street 1:8929 WASHINGTON TRACE RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:KY
Practice Address - Zip Code:41007-9089
Practice Address - Country:US
Practice Address - Phone:859-609-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN255770163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse