Doctor Name: | ANGELA M VANDERBERG |
NPI Number: | 1093019994 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 71003513 |
Business Practice Address: | 213 S Court St Suite B Crown Point, IN - 463073990 |
Business Phone Number: | 2196634888 |
Business Fax Number: | 2196634877 |
Mailing Address: | 213 S Court St, Suite B CROWN POINT |
State: | IN |
Postal Code: | 463073990 |
Phone Number: | 2196634888 |
Fax Number: | 2196634877 |
NPI Enumeration Date: | 01/06/2011 |
NPI Last Update Date: | 04/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71003513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |