Provider Demographics
NPI:1356350185
Name:REU, ANGELA L (PAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:REU
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32021 COUNTRY 24 BLVD
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-3723
Mailing Address - Country:US
Mailing Address - Phone:507-263-4221
Mailing Address - Fax:
Practice Address - Street 1:32021 COUNTRY 24 BLVD
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-3723
Practice Address - Country:US
Practice Address - Phone:507-263-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant