Provider Demographics
NPI:1730313479
Name:LUEDKE, ANGELA JANE (IDMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JANE
Last Name:LUEDKE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 57 BOX 226
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09610-9998
Mailing Address - Country:US
Mailing Address - Phone:39333-483-9271
Mailing Address - Fax:
Practice Address - Street 1:PSC 57 BOX 226
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09610-9998
Practice Address - Country:US
Practice Address - Phone:39333-483-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians