Provider Demographics
NPI:1659981819
Name:ANDERSON, ANGELA RENEE
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23410 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2438
Mailing Address - Country:US
Mailing Address - Phone:248-425-0530
Mailing Address - Fax:
Practice Address - Street 1:23410 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2438
Practice Address - Country:US
Practice Address - Phone:248-425-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide