Provider Demographics
NPI:1912375122
Name:VIVIANO, ANGELA VALENTINA (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:VALENTINA
Last Name:VIVIANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6458 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15959 HALL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5363
Practice Address - Country:US
Practice Address - Phone:586-247-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily