Provider Demographics
NPI:1376985796
Name:SEAGREN, ANGELA G (RN, CH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:SEAGREN
Suffix:
Gender:F
Credentials:RN, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7364 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-9673
Mailing Address - Country:US
Mailing Address - Phone:608-547-4722
Mailing Address - Fax:
Practice Address - Street 1:1216 MARK AVE
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1199
Practice Address - Country:US
Practice Address - Phone:608-547-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175886-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse