Provider Demographics
NPI:1588781025
Name:WASHINGTON, ANGELNIQUE RAQUEL (STNA)
Entity type:Individual
Prefix:MS
First Name:ANGELNIQUE
Middle Name:RAQUEL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4616
Mailing Address - Country:US
Mailing Address - Phone:937-554-0690
Mailing Address - Fax:
Practice Address - Street 1:1709 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4616
Practice Address - Country:US
Practice Address - Phone:937-554-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH378563131099376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide