Individual
MS. ANGELA DAWN NUCKOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
401 S QUEEN ST, MARTINSBURG, WV 25401-3233
(304) 264-5055
Mailing address
62 PAYNES FORD RD, MARTINSBURG, WV 25405-5799
(304) 262-1576
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7403022000
—
WV
Enumeration date
04/12/2008
Last updated
04/12/2008
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