Provider Demographics
NPI:1629459177
Name:WALDMAN, ANGELA (PC-PNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PC-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PACKARD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2061
Mailing Address - Country:US
Mailing Address - Phone:734-572-8686
Mailing Address - Fax:734-572-8866
Practice Address - Street 1:2900 PACKARD RD STE 1
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2061
Practice Address - Country:US
Practice Address - Phone:734-572-8686
Practice Address - Fax:734-572-8866
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304817363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics