Provider Demographics
NPI:1114737624
Name:DIENAAR, ANGELICA LIZZA RUTH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LIZZA RUTH
Last Name:DIENAAR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WARESIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:ETOBICOKE
Mailing Address - State:ON
Mailing Address - Zip Code:M9C 3B7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY942738163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse