Provider Demographics
NPI:1710123062
Name:MACMILLAN, ANGELA M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EATON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1895
Mailing Address - Country:US
Mailing Address - Phone:484-526-2894
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:800 EATON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1895
Practice Address - Country:US
Practice Address - Phone:484-526-2894
Practice Address - Fax:484-526-6500
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010016363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology