| Doctor Name: | ANGELA S DECLUE |
| NPI Number: | 1659343903 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 132460 |
| Business Practice Address: | 200 Health Way Dr Potosi, MO - 636641434 |
| Business Phone Number: | 5734382977 |
| Business Fax Number: | 5734382874 |
| Mailing Address: | 200 Health Way Dr, POTOSI |
| State: | MO |
| Postal Code: | 636641434 |
| Phone Number: | 5734382977 |
| Fax Number: | 5734382874 |
| NPI Enumeration Date: | 02/02/2006 |
| NPI Last Update Date: | 06/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 132460 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |