Provider Demographics
NPI:1639844889
Name:PEMBROKE, ANGELA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEMBROKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WATSON POWELL JR WAY
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1725
Mailing Address - Country:US
Mailing Address - Phone:515-243-2888
Mailing Address - Fax:
Practice Address - Street 1:320 WATSON POWELL JR WAY
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1725
Practice Address - Country:US
Practice Address - Phone:515-243-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA164687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner