Provider Demographics
NPI:1285057380
Name:ANGANU, TRICIA
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:ANGANU
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 1:1820 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5315
Mailing Address - Country:US
Mailing Address - Phone:516-582-2937
Mailing Address - Fax:516-579-3220
Practice Address - Street 1:1820 OAK ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5315
Practice Address - Country:US
Practice Address - Phone:516-582-2937
Practice Address - Fax:516-579-3220
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse