1639443146 NPI number — ANGELA D NOWELL ARNP

Table of content: ANGELA D NOWELL ARNP (NPI 1639443146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639443146 NPI number — ANGELA D NOWELL ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOWELL
Provider First Name:
ANGELA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOWELL BLANCHARD
Provider Other First Name:
ANGELA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639443146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 WEST PLEASANT RUN ROAD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-857-5439
Provider Business Mailing Address Fax Number:
469-857-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 WEST PLEASANT RUN ROAD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-857-5439
Provider Business Practice Location Address Fax Number:
469-857-5444
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  ARNP3178092 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3692956 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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