Provider Demographics
NPI:1124729454
Name:CLAIRVIL SENE, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:CLAIRVIL SENE
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 1:1805 RESERVOIR RD APT 26
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6603
Mailing Address - Country:US
Mailing Address - Phone:516-343-4734
Mailing Address - Fax:516-343-4734
Practice Address - Street 1:1805 RESERVOIR RD APT 26
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6603
Practice Address - Country:US
Practice Address - Phone:516-343-4734
Practice Address - Fax:516-343-4734
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide