MEDICARE: CHERRY ANN D'ANGELO CRNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	363LA2200X	Adult Health Nurse Practitioner	SP009534	PA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP010882	PA

General Provider Information

NPI Number	:	1578620506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRY ANN D'ANGELO CRNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3820 BRIDGES ST
Second Line	:	SUITE B
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2978
Country	:	US
Telephone Number	:	252-648-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 BRIDGES ST
Second Line	:	SUITE B
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2978
Country	:	US
Telephone Number	:	252-648-3124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/17/2014

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