Provider Demographics
NPI:1003470923
Name:ANGELL, EARLENE MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:EARLENE
Middle Name:MARIE
Last Name:ANGELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CENTURY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3771
Mailing Address - Country:US
Mailing Address - Phone:563-599-6991
Mailing Address - Fax:
Practice Address - Street 1:805 CENTURY DR STE 5
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3771
Practice Address - Country:US
Practice Address - Phone:563-599-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG154268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health