Provider Demographics
NPI:1225006695
Name:SWEENEY, ANGELA M (MSN APNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MSN APNP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:STEFANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN APNP
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-375-3700
Mailing Address - Fax:262-376-6032
Practice Address - Street 1:215 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1700
Practice Address - Country:US
Practice Address - Phone:262-375-3700
Practice Address - Fax:262-376-6032
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2700033363LA2200X
WI2700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225006695Medicaid
WI41278100Medicaid
WI1225006695Medicaid
WI41278100Medicaid
WIK400359288Medicare PIN