Provider Demographics
NPI:1659020899
Name:MORALES-TALAVERA, ANGELA CHRISTINA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINA
Last Name:MORALES-TALAVERA
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 1:1485 E MAPLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-5601
Mailing Address - Country:US
Mailing Address - Phone:414-350-6553
Mailing Address - Fax:
Practice Address - Street 1:5801 WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4057
Practice Address - Country:US
Practice Address - Phone:262-886-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11441-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner