Provider Demographics
NPI:1528033735
Name:WARE, VANGELEEN C (NP)
Entity Type:Individual
Prefix:
First Name:VANGELEEN
Middle Name:C
Last Name:WARE
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Mailing Address - Street 1:4229 SNAPFINGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3440
Mailing Address - Country:US
Mailing Address - Phone:404-286-9252
Mailing Address - Fax:404-286-9253
Practice Address - Street 1:4229 SNAPFINGER WOODS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3440
Practice Address - Country:US
Practice Address - Phone:404-286-9252
Practice Address - Fax:404-286-9253
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN141261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA963856379AMedicaid