Provider Demographics
NPI:1255143392
Name:WLOCK, ANGELINE (MSN, AGPCNP-C, CHPN)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:WLOCK
Suffix:
Gender:F
Credentials:MSN, AGPCNP-C, CHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 DEXTER CORNER RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-9245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 E LOOCKERMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3779
Practice Address - Country:US
Practice Address - Phone:302-678-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031933363L00000X
DELP-0010861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner