Provider Demographics
NPI:1740485085
Name:STREET, ANGELA LYNETTE (CRNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNETTE
Last Name:STREET
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4809 HAWKSBURY RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2142
Mailing Address - Country:US
Mailing Address - Phone:410-963-5048
Mailing Address - Fax:410-328-6956
Practice Address - Street 1:4809 HAWKSBURY RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2142
Practice Address - Country:US
Practice Address - Phone:410-963-5048
Practice Address - Fax:410-328-6956
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR097716363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner