Provider Demographics
NPI:1437529138
Name:NORTZ, ANGELA KIM (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KIM
Last Name:NORTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20104 NYS RT 3
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5560
Mailing Address - Country:US
Mailing Address - Phone:315-779-7100
Mailing Address - Fax:315-779-7109
Practice Address - Street 1:5439 SHADY AVE
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1615
Practice Address - Country:US
Practice Address - Phone:315-377-7365
Practice Address - Fax:315-377-7380
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502824-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool