Provider Demographics
NPI:1023711694
Name:BAKALAR, ANGELA RENEE (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:BAKALAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:BAKALAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:317 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IA
Mailing Address - Zip Code:50116-7519
Mailing Address - Country:US
Mailing Address - Phone:416-891-1728
Mailing Address - Fax:515-699-5952
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5999
Practice Address - Fax:515-699-5952
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA148683163WE0003X, 163WH1000X, 163WR0400X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation