Provider Demographics
NPI:1871032151
Name:VALDEZ, ANGELENA MARIE
Entity Type:Individual
Prefix:
First Name:ANGELENA
Middle Name:MARIE
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELENA
Other - Middle Name:MARIE
Other - Last Name:KANDAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANGELENA ZOBEL
Mailing Address - Street 1:1707 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4007
Mailing Address - Country:US
Mailing Address - Phone:734-707-7004
Mailing Address - Fax:
Practice Address - Street 1:1707 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4007
Practice Address - Country:US
Practice Address - Phone:734-707-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily