Provider Demographics
NPI:1679395925
Name:POOLE, ANGELA WILLIAMSON (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:WILLIAMSON
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 CORALVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3316
Mailing Address - Country:US
Mailing Address - Phone:804-640-1092
Mailing Address - Fax:
Practice Address - Street 1:720 CORALVIEW CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3316
Practice Address - Country:US
Practice Address - Phone:804-640-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001081802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse