Provider Demographics
NPI:1952553356
Name:NIEVES-PETEANI, ANGELA DORE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DORE
Last Name:NIEVES-PETEANI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 EAST FORDHAM ROAD
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-817-4160
Mailing Address - Fax:
Practice Address - Street 1:441 EAST FORDHAM ROAD
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-817-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302520363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health