Provider Demographics
NPI:1811708795
Name:GILLESPIE, ANGELIA M
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:M
Last Name:GILLESPIE
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 1:11903 ESPLANADA CT APT 715
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3135
Mailing Address - Country:US
Mailing Address - Phone:402-983-4914
Mailing Address - Fax:
Practice Address - Street 1:706 KOUNTZE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2529
Practice Address - Country:US
Practice Address - Phone:402-707-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care