Provider Demographics
NPI:1063987071
Name:RHODEN ANGEL, RHONDA RENEE
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:RENEE
Last Name:RHODEN ANGEL
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 1:2425 E NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-4542
Mailing Address - Country:US
Mailing Address - Phone:217-377-6018
Mailing Address - Fax:
Practice Address - Street 1:1606 WILLOW VIEW RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-7475
Practice Address - Country:US
Practice Address - Phone:217-377-6018
Practice Address - Fax:217-607-0588
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHF115142251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health