Provider Demographics
NPI:1811414303
Name:ANDERSON, ANGELA KAYE (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 260TH ST
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-7739
Mailing Address - Country:US
Mailing Address - Phone:712-317-1130
Mailing Address - Fax:712-317-1140
Practice Address - Street 1:302 W PHILLIP AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5248
Practice Address - Country:US
Practice Address - Phone:402-371-8000
Practice Address - Fax:402-371-0971
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112322363LF0000X
IAA161589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEXXXX40301Medicaid