Provider Demographics
NPI:1942883558
Name:RUSAN, ANGELA (EMT, SOCIOLOGIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RUSAN
Suffix:
Gender:F
Credentials:EMT, SOCIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 SHENANDOAH AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1774
Mailing Address - Country:US
Mailing Address - Phone:314-203-0974
Mailing Address - Fax:314-626-4655
Practice Address - Street 1:3556 SHENANDOAH AVE APT 302
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1774
Practice Address - Country:US
Practice Address - Phone:314-203-0974
Practice Address - Fax:314-626-4655
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB66554146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty