Provider Demographics
NPI:1053189704
Name:YORK, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 DESERT SENNA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4717
Mailing Address - Country:US
Mailing Address - Phone:702-409-8269
Mailing Address - Fax:
Practice Address - Street 1:4423 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3703
Practice Address - Country:US
Practice Address - Phone:702-458-1137
Practice Address - Fax:702-458-1423
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN14598164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse