Provider Demographics
NPI:1831496363
Name:ANGLEN, RICK (PA)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:ANGLEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:901 SAINT MARYS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0520
Mailing Address - Country:US
Mailing Address - Phone:812-473-2642
Mailing Address - Fax:812-474-4458
Practice Address - Street 1:901 SAINT MARYS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0520
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:812-474-4458
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000154A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN273474697OtherTAX ID
IN1669780029OtherGROUP NPI