Provider Demographics
NPI:1720264922
Name:BLUDAU, ANGELA D (WHCNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:BLUDAU
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHCNP
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:
Practice Address - Street 1:4206 RETAMA CIR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2765
Practice Address - Country:US
Practice Address - Phone:361-576-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595240363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82118NMedicare PIN
TXS71931Medicare UPIN