Provider Demographics
NPI:1245078922
Name:HEROUX, ANGELA MICHELLE (DNP)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:HEROUX
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-3164
Mailing Address - Country:US
Mailing Address - Phone:716-777-1208
Mailing Address - Fax:
Practice Address - Street 1:301 ASHVILLE AVE STE 111
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6131
Practice Address - Country:US
Practice Address - Phone:919-233-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily