Provider Demographics
NPI:1740926153
Name:ANGELICA, DENISE
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:ANGELICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 VIREO DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6126
Mailing Address - Country:US
Mailing Address - Phone:985-869-2000
Mailing Address - Fax:
Practice Address - Street 1:415 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3137
Practice Address - Country:US
Practice Address - Phone:985-892-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA077027163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool