Provider Demographics
NPI:1982875332
Name:ANGELO, BLANCHE (LPN)
Entity Type:Individual
Prefix:
First Name:BLANCHE
Middle Name:
Last Name:ANGELO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 BILLINGS RD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-5506
Mailing Address - Country:US
Mailing Address - Phone:607-674-2324
Mailing Address - Fax:
Practice Address - Street 1:298 BILLINGS RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-5506
Practice Address - Country:US
Practice Address - Phone:607-674-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259602-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY259602-1OtherLPN LICENSE NUMBER