Provider Demographics
NPI:1588294243
Name:WASHINGTON, ANGELIC DAWN (AGPCNP-BC)
Entity type:Individual
Prefix:DR
First Name:ANGELIC
Middle Name:DAWN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1186
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1186
Practice Address - Country:US
Practice Address - Phone:937-548-3806
Practice Address - Fax:937-548-2087
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28258584A163W00000X
OH321961163W00000X
TN0000181017163W00000X
OHAPRN.CNP.026649363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty