Provider Demographics
NPI:1427318872
Name:ANGEL, TERRI (RN)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:ANGEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-7701
Mailing Address - Country:US
Mailing Address - Phone:859-391-6117
Mailing Address - Fax:
Practice Address - Street 1:1075 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-7701
Practice Address - Country:US
Practice Address - Phone:859-391-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1123870163W00000X
OHRN.376129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse