Individual
ANGELA DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 E 55TH ST, BROOKLYN, NY 11234-1701
(347) 517-2452
Mailing address
1001 E 55TH ST, BROOKLYN, NY 11234-1701
(347) 517-2452
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
436104-1
NY
163WM0705X
Medical-Surgical Registered Nurse
Primary
436104-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
436104-1
RN LICENSURE
NY
Enumeration date
10/28/2017
Last updated
10/28/2017
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