Provider Demographics
NPI:1497966402
Name:ALLEN, ANGELA DAVIS (RN, ROS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAVIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN, ROS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PAULS PATH RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-8381
Mailing Address - Country:US
Mailing Address - Phone:252-566-9644
Mailing Address - Fax:
Practice Address - Street 1:227 KINGOLD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68319163W00000X, 163WC1500X, 163WP0200X, 163WW0101X
246QL0900X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68319OtherRN LICENSE #