Provider Demographics
NPI:1265058648
Name:TURNER, ANGELA M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:TURNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:2307 LAPORTE AVE STE 8
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6997
Practice Address - Country:US
Practice Address - Phone:219-464-7073
Practice Address - Fax:219-464-7543
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010071A363LF0000X
IN28216496A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN56-2580101Medicaid