Provider Demographics
NPI:1023573268
Name:DEMIEN, ANGELA GAY (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GAY
Last Name:DEMIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENLEAF WOODS DR # 03801
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5454
Mailing Address - Country:US
Mailing Address - Phone:603-749-2346
Mailing Address - Fax:
Practice Address - Street 1:8 GREENLEAF WOODS DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5454
Practice Address - Country:US
Practice Address - Phone:603-749-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NH1438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical