Provider Demographics
NPI:1235370529
Name:VEDDER, ANGELA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:VEDDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2097 E. WASHINGTON ST.,1-E#297
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4738
Mailing Address - Country:US
Mailing Address - Phone:909-498-6409
Mailing Address - Fax:
Practice Address - Street 1:17291 IRVINE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2932
Practice Address - Country:US
Practice Address - Phone:714-573-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN375925163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse