Provider Demographics
NPI:1083411375
Name:HERMESKY, ANGELA AIDA (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:AIDA
Last Name:HERMESKY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 BENZINGER RD
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8073
Mailing Address - Country:US
Mailing Address - Phone:916-664-1517
Mailing Address - Fax:
Practice Address - Street 1:6505 S MANTHEY RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9518
Practice Address - Country:US
Practice Address - Phone:916-664-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse