Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G154268 | IA |
NPI | 1003470923 |
---|---|
Provider Name | Ms. Earlene Marie Angell |
First Address | Dubuque, IA 52002-3771 |
Second Address | Dubuque, IA 52002-3771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 22/06/2019 |