Provider Demographics
NPI:1538205026
Name:GASKIN, ANGELA MARIE
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:GASKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MARSHALL ST
Mailing Address - Street 2:BOX 134
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5852
Mailing Address - Country:US
Mailing Address - Phone:336-722-8685
Mailing Address - Fax:336-889-5894
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:BOX 134
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-722-8685
Practice Address - Fax:336-889-5894
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6600931251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health