Provider Demographics
NPI:1114277399
Name:ESPINAL, ANGELIA B (NP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:B
Last Name:ESPINAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:B
Other - Last Name:SKRUMBELLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANGELIA B COLE
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6900
Mailing Address - Fax:414-955-6204
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-6900
Practice Address - Fax:414-955-6204
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114277399Medicaid
WI736012618Medicare PIN