Healthcare Provider Details

I. General information

NPI: 1992807796
Provider Name (Legal Business Name): AUDREY ANGEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 LAKESIDE VLG COMMONS
CHICO CA
95928-3979
US

IV. Provider business mailing address

9032 GOODSPEED ST
DURHAM CA
95938-9723
US

V. Phone/Fax

Practice location:
  • Phone: 530-332-6337
  • Fax: 530-893-6936
Mailing address:
  • Phone: 530-332-6337
  • Fax: 530-893-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP10164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: