Provider Demographics
NPI:1164830410
Name:UMBRO-HUSSEY, ANGELA ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANN
Last Name:UMBRO-HUSSEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:963 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3332
Practice Address - Country:US
Practice Address - Phone:207-396-7700
Practice Address - Fax:207-396-7701
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400238525Medicare PIN
MEE400238523Medicare PIN