Provider Demographics
NPI:1215121025
Name:IMES, ANGELA DENICE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENICE
Last Name:IMES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 WEATHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2658
Mailing Address - Country:US
Mailing Address - Phone:910-864-2119
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL ONE STOP ROOM 12, NORMANDY DRIVE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-396-6243
Practice Address - Fax:910-396-6224
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103193163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse