Provider Demographics
NPI:1861631921
Name:RANSOM, ANGELA (CNP RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:CNP RN
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5971
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:14555 LEVAN RD STE 116
Practice Address - Street 2:ST. MARY'S MERCY - LIVONIA
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5085
Practice Address - Country:US
Practice Address - Phone:877-486-7978
Practice Address - Fax:313-993-0303
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2013-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704259033363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32180048Medicare PIN