Healthcare Provider Details

I. General information

NPI: 1992306294
Provider Name (Legal Business Name): ANGELA MAMAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 WATERBRIDGE WAY
EVANSVILLE IN
47710-3200
US

IV. Provider business mailing address

2830 WOODSIDE CT
EVANSVILLE IN
47711-6731
US

V. Phone/Fax

Practice location:
  • Phone: 812-204-0365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number28216051A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: