Provider Demographics
NPI:1255720348
Name:PONTIUS, ANGELA RENE' (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENE'
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 9TH AVE S
Mailing Address - Street 2:155 COMMUNITY CARE BUILDING
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0007
Mailing Address - Country:US
Mailing Address - Phone:205-996-2780
Mailing Address - Fax:205-975-7764
Practice Address - Street 1:ZRB 239
Practice Address - Street 2:1720 2ND AVENUE SOUTH
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0007
Practice Address - Country:US
Practice Address - Phone:205-996-2780
Practice Address - Fax:205-975-7764
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087382163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL#F0614047OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION
AL1-087382OtherALABAMA BOARD OF NURSING LICENSE
AL4651OtherCRNP RX NUMBER