Provider Demographics
NPI:1760523815
Name:NEIS, ANGIE C (CPM-TN)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:C
Last Name:NEIS
Suffix:
Gender:F
Credentials:CPM-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5466
Mailing Address - Country:US
Mailing Address - Phone:423-434-2102
Mailing Address - Fax:
Practice Address - Street 1:304 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5466
Practice Address - Country:US
Practice Address - Phone:423-434-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000014176B00000X
175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay