Provider Demographics
NPI:1023599651
Name:SOBIECK, ANGELA M
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SOBIECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 ENGLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2228
Mailing Address - Country:US
Mailing Address - Phone:260-432-1800
Mailing Address - Fax:260-432-1804
Practice Address - Street 1:7201 ENGLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2228
Practice Address - Country:US
Practice Address - Phone:260-432-1800
Practice Address - Fax:260-432-1804
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160343A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71008275AOtherIN NP LICENSE
IN300017773Medicaid
IN28160343AOtherINDIANA RN LICENSE