Provider Demographics
NPI:1134743495
Name:HARPER, ANGELA N
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:HARPER
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 1:23473 W HOPI ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6293
Mailing Address - Country:US
Mailing Address - Phone:623-308-6640
Mailing Address - Fax:623-248-7810
Practice Address - Street 1:23473 W HOPI ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6293
Practice Address - Country:US
Practice Address - Phone:623-308-6640
Practice Address - Fax:623-248-7810
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ003876Medicaid