Provider Demographics
NPI:1043721319
Name:PRINCE, ANGELA KAY (DME PROVIDER)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DME PROVIDER
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 E ROUND GROVE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8380
Mailing Address - Country:US
Mailing Address - Phone:214-488-8885
Mailing Address - Fax:
Practice Address - Street 1:500 E ROUND GROVE RD STE 301
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8380
Practice Address - Country:US
Practice Address - Phone:214-488-8885
Practice Address - Fax:972-316-8885
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCFM03106224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter