Provider Demographics
NPI:1487865473
Name:CAPO, ANGELA F (APN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:F
Last Name:CAPO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:F
Other - Last Name:CAPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MSN
Mailing Address - Street 1:22 ASHLYN COURT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6402
Mailing Address - Country:US
Mailing Address - Phone:973-696-8016
Mailing Address - Fax:973-696-8294
Practice Address - Street 1:165 FAIRFIELD ROAD
Practice Address - Street 2:WEST CALDWELL CARE CENTER
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-226-1100
Practice Address - Fax:973-226-5993
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04845100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7432003Medicaid
CA001748Medicare ID - Type Unspecified