Provider Demographics
NPI:1639739469
Name:VANMATRE, ANGELA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:VANMATRE
Suffix:
Gender:F
Credentials:FNP
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 1738
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-7738
Mailing Address - Country:US
Mailing Address - Phone:812-396-9863
Mailing Address - Fax:
Practice Address - Street 1:12100 HIGHWAY 41 N STE 1
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7032
Practice Address - Country:US
Practice Address - Phone:812-868-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06190446363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner