Provider Demographics
NPI:1295622173
Name:KHAN, ANGELICA JEAN
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:JEAN
Last Name:KHAN
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 1:1314 W PASEWALK AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4854
Mailing Address - Country:US
Mailing Address - Phone:402-454-5375
Mailing Address - Fax:
Practice Address - Street 1:1314 W PASEWALK AVE APT 8
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4854
Practice Address - Country:US
Practice Address - Phone:402-454-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion