Healthcare Provider Details

I. General information

NPI: 1255606786
Provider Name (Legal Business Name): ANGELA JOY WEINZAPFEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA JOY BUTLER CRNA

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 13TH ST SUITE 100
JASPER IN
47546-1881
US

IV. Provider business mailing address

600 W 13TH ST SUITE 100
JASPER IN
47546-1881
US

V. Phone/Fax

Practice location:
  • Phone: 812-483-2228
  • Fax:
Mailing address:
  • Phone: 812-483-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28161162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: