Provider Demographics
NPI:1013364405
Name:FIELDS, ANGELA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CASTLEWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24224-6397
Mailing Address - Country:US
Mailing Address - Phone:276-794-9165
Mailing Address - Fax:
Practice Address - Street 1:1240 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CASTLEWOOD
Practice Address - State:VA
Practice Address - Zip Code:24224-6397
Practice Address - Country:US
Practice Address - Phone:276-794-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173522363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care