Provider Demographics
NPI:1194123737
Name:LIDE, ANGELA PATRICIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PATRICIA
Last Name:LIDE
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 1:745 E 231ST ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4175
Mailing Address - Country:US
Mailing Address - Phone:718-664-0298
Mailing Address - Fax:
Practice Address - Street 1:745 E 231ST ST APT 4F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4175
Practice Address - Country:US
Practice Address - Phone:718-664-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320059164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse