Provider Demographics
NPI:1033495585
Name:MATHIAS, ANGELA L (SRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:SRNA
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Mailing Address - Street 1:164 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2728
Mailing Address - Country:US
Mailing Address - Phone:920-965-4055
Mailing Address - Fax:920-405-5388
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-3388
Practice Address - Fax:920-288-3370
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2022-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI0158611-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered