Provider Demographics
NPI:1326079286
Name:SOBIESK, ANGELA G (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:G
Last Name:SOBIESK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BRIDGE CREEK CV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1711
Mailing Address - Country:US
Mailing Address - Phone:337-856-9748
Mailing Address - Fax:
Practice Address - Street 1:449 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2616
Practice Address - Country:US
Practice Address - Phone:337-235-2264
Practice Address - Fax:337-232-4426
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1478342Medicaid
LA4H283CN17Medicare ID - Type Unspecified
LA1478342Medicaid