Provider Demographics
NPI:1982268991
Name:KALLEK, ANGELA KAY-ROSE (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY-ROSE
Last Name:KALLEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAY-ROSE
Other - Last Name:SZTABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:84 KANEOHE BAY DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1755
Mailing Address - Country:US
Mailing Address - Phone:586-321-2044
Mailing Address - Fax:
Practice Address - Street 1:46-202 HAIKU RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3806
Practice Address - Country:US
Practice Address - Phone:808-233-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI87818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse