Provider Demographics
NPI:1699081505
Name:DRAKE, ANGEL NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:NICOLE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 7 GABLES AVE
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2114
Mailing Address - Country:US
Mailing Address - Phone:937-837-8820
Mailing Address - Fax:
Practice Address - Street 1:5716 7 GABLES AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2114
Practice Address - Country:US
Practice Address - Phone:937-837-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse