Provider Demographics
NPI:1184106825
Name:CONNOR, ANGELA AKLADISS (ACNP-AG)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:AKLADISS
Last Name:CONNOR
Suffix:
Gender:F
Credentials:ACNP-AG
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:BETH
Other - Last Name:AKLADISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 SACKVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1954
Mailing Address - Country:US
Mailing Address - Phone:207-212-9704
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty