Provider Demographics
NPI:1619326402
Name:PERSOHN, ANGELA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PERSOHN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-1088
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:407 E 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-8964
Practice Address - Country:US
Practice Address - Phone:812-683-3612
Practice Address - Fax:812-683-2819
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006321A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily