Provider Demographics
NPI:1356753677
Name:D'ANGELO, KATHRYN L (APN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2216
Mailing Address - Country:US
Mailing Address - Phone:856-220-5013
Mailing Address - Fax:
Practice Address - Street 1:181 W WHITE HORSE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-3234
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00499300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily