Provider Demographics
NPI:1275058216
Name:MACKNER, ANGELA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MACKNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14319 385TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57460-6910
Mailing Address - Country:US
Mailing Address - Phone:605-380-0271
Mailing Address - Fax:
Practice Address - Street 1:201 S LLOYD ST STE W190
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4509
Practice Address - Country:US
Practice Address - Phone:605-225-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner