Provider Demographics
NPI:1083267363
Name:MINIUM, ANGELA MARIE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MINIUM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:HOLMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 CENTRAL PARK SQ
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4021
Mailing Address - Country:US
Mailing Address - Phone:056-625-4798
Mailing Address - Fax:
Practice Address - Street 1:118 CENTRAL PARK SQ
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4021
Practice Address - Country:US
Practice Address - Phone:505-662-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily