Provider Demographics
NPI:1407286412
Name:GARDNER-ARYEETEY FNP-BC, ANGELA (APNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GARDNER-ARYEETEY FNP-BC
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ARYEETEY FNP-BC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 240873
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-9023
Mailing Address - Country:US
Mailing Address - Phone:414-732-6132
Mailing Address - Fax:
Practice Address - Street 1:5678 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2356
Practice Address - Country:US
Practice Address - Phone:414-732-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5455-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily