Provider Demographics
NPI:1114924743
Name:ZACHAREK, ANGELA SUE (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUE
Last Name:ZACHAREK
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 COBURG RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4945
Mailing Address - Country:US
Mailing Address - Phone:541-686-2959
Mailing Address - Fax:
Practice Address - Street 1:1860 COBURG RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4945
Practice Address - Country:US
Practice Address - Phone:541-686-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR200650156NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily