Provider Demographics
NPI:1487738779
Name:LIKELY, ANGELIQUE RENEE (RN, MPH)
Entity type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:RENEE
Last Name:LIKELY
Suffix:
Gender:F
Credentials:RN, MPH
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Other - Credentials:
Mailing Address - Street 1:4100 GROSS RD
Mailing Address - Street 2:FOX ARMY HEALT CENTER (CREDENTIALS)
Mailing Address - City:REDSTONE ARSENAL
Mailing Address - State:AL
Mailing Address - Zip Code:36809-7000
Mailing Address - Country:US
Mailing Address - Phone:256-955-6492
Mailing Address - Fax:256-842-2019
Practice Address - Street 1:4100 GROSS RD
Practice Address - Street 2:FOX ARMY HEALT CENTER (PREVENTIVE MEDICINE)
Practice Address - City:REDSTONE ARSENAL
Practice Address - State:AL
Practice Address - Zip Code:36809-7000
Practice Address - Country:US
Practice Address - Phone:256-955-8888
Practice Address - Fax:256-955-0364
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX613024163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN