Provider Demographics
NPI:1629585377
Name:WILTSE, ANGELA M (DNP, CRNP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:WILTSE
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:GOLEMBIESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:14090 HG TRUEMAN RD.
Practice Address - Street 2:SUITE 2500
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRI34727363L00000X
MDR134727363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily