Provider Demographics
NPI:1881416113
Name:DALE, ANGEL (CHW)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1027
Mailing Address - Country:US
Mailing Address - Phone:402-362-2621
Mailing Address - Fax:402-362-2687
Practice Address - Street 1:2101 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1027
Practice Address - Country:US
Practice Address - Phone:402-362-2621
Practice Address - Fax:402-362-2687
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker