Provider Demographics
NPI:1962486126
Name:BASTIAN, ANGELA MILLER (APRN, CNS)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MILLER
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:APRN, CNS
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Mailing Address - Street 1:317 OAK KNOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2616
Mailing Address - Country:US
Mailing Address - Phone:507-387-3217
Mailing Address - Fax:
Practice Address - Street 1:410 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4588
Practice Address - Country:US
Practice Address - Phone:507-304-4319
Practice Address - Fax:507-304-4387
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 155512-7364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN567108Medicare UPIN