Basic Information
| Provider Information | |||||||||
| NPI: | 1851998108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | DALTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 ANDERSON RD | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272888101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365581318 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3580 NC HIGHWAY 14 | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273208746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365225095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 47443 | NC | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.