Provider Demographics
NPI:1114174737
Name:SMITH, ANGELA M (DNP, PMHNP-BC, CMGT)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, CMGT
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:KLUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN/ED, CDCES
Mailing Address - Street 1:20304 W WHITE TANKS MTN RD STE A
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9895
Mailing Address - Country:US
Mailing Address - Phone:419-566-3319
Mailing Address - Fax:
Practice Address - Street 1:9250 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3382
Practice Address - Country:US
Practice Address - Phone:602-815-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN236161163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator