Provider Demographics
NPI:1457780520
Name:HIEBERT, ANGELA (RN, MN, NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HIEBERT
Suffix:
Gender:F
Credentials:RN, MN, NP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LOEWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:BMT OFFICE 2ND FLOOR MAIN HOSPITAL
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-597-7169
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:BMT OFFICE 2ND FLOOR MAIN HOSPITAL
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-597-7169
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722750163W00000X
CA22164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse