Provider Demographics
NPI:1366474132
Name:MCGREGOR, ANGELA J (DNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3430
Mailing Address - Country:US
Mailing Address - Phone:319-524-6274
Mailing Address - Fax:
Practice Address - Street 1:1603 MORGAN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3430
Practice Address - Country:US
Practice Address - Phone:319-524-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37300OtherWELLMARK
IA1366474132Medicare PIN
IAQ25111Medicare UPIN