Provider Demographics
NPI:1528740586
Name:NETTLES, ANGEL MARIAH
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIAH
Last Name:NETTLES
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 1:35 STANFORD RD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:AL
Mailing Address - Zip Code:36425-4336
Mailing Address - Country:US
Mailing Address - Phone:251-244-8980
Mailing Address - Fax:
Practice Address - Street 1:35 STANFORD RD
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:AL
Practice Address - Zip Code:36425-4336
Practice Address - Country:US
Practice Address - Phone:251-244-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program