Provider Demographics
NPI:1194445601
Name:ANGELO, AMY MICHELE (LPN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELE
Last Name:ANGELO
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 1:52 GATSBY DR APT 1
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-8073
Mailing Address - Country:US
Mailing Address - Phone:508-208-0552
Mailing Address - Fax:
Practice Address - Street 1:52 GATSBY DR APT 1
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-8073
Practice Address - Country:US
Practice Address - Phone:508-208-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN96466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse