Provider Demographics
NPI:1851067334
Name:HARNER, ANGELA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HARNER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 NOKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-1809
Mailing Address - Country:US
Mailing Address - Phone:703-577-5987
Mailing Address - Fax:
Practice Address - Street 1:20680 SENECA MEADOWS PKWY STE 206
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7029
Practice Address - Country:US
Practice Address - Phone:301-339-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008114363A00000X
363A00000X
MDC0008171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant