Provider Demographics
NPI:1932617925
Name:ANGLE, JANE MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:ANGLE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:HEROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:660 MASON RIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8509
Mailing Address - Country:US
Mailing Address - Phone:314-273-6481
Mailing Address - Fax:
Practice Address - Street 1:660 MASON RIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8509
Practice Address - Country:US
Practice Address - Phone:314-273-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022530363LA2200X
MO2017002557363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health