1639852841 NPI number — ANGELA UNETTE VICK CERTIFIED NURSE ASSI

Table of content: ANGELA UNETTE VICK CERTIFIED NURSE ASSI (NPI 1639852841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639852841 NPI number — ANGELA UNETTE VICK CERTIFIED NURSE ASSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICK
Provider First Name:
ANGELA
Provider Middle Name:
UNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED NURSE ASSI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VICK
Provider Other First Name:
ANGELIA
Provider Other Middle Name:
UNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639852841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 JASMINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-8915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-469-1742
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 JASMINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-8915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-469-1742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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