Provider Demographics
NPI:1699168054
Name:HOLBROOK, ANGEL (CNA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5773
Mailing Address - Country:US
Mailing Address - Phone:907-228-6558
Mailing Address - Fax:
Practice Address - Street 1:3054 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5773
Practice Address - Country:US
Practice Address - Phone:907-228-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK14350376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide