Provider Demographics
NPI:1760718993
Name:STEGENGA, ANGIE LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:LYNN
Last Name:STEGENGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8488
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:12380 PLAZA DR STE 101
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8488
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily