Provider Demographics
NPI:1659672905
Name:ANGUS, LINDA JO (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JO
Last Name:ANGUS
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043-7046
Mailing Address - Country:US
Mailing Address - Phone:304-587-7301
Mailing Address - Fax:304-587-2464
Practice Address - Street 1:122 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043-7046
Practice Address - Country:US
Practice Address - Phone:304-587-7301
Practice Address - Fax:304-587-2464
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV68732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1659762905Medicaid