Provider Demographics
NPI:1912711136
Name:JIMENEZ, ANGELA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANN
Last Name:JIMENEZ
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 1:422 RUSHMORE LN APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1144
Mailing Address - Country:US
Mailing Address - Phone:609-949-0548
Mailing Address - Fax:
Practice Address - Street 1:422 RUSHMORE LN APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1144
Practice Address - Country:US
Practice Address - Phone:609-949-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332671-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty