Healthcare Provider Details

I. General information

NPI: 1104759539
Provider Name (Legal Business Name): ANGEL CAZARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 N BRIARWOOD LN
MUNCIE IN
47304-6375
US

IV. Provider business mailing address

3640 N BRIARWOOD LN
MUNCIE IN
47304-6375
US

V. Phone/Fax

Practice location:
  • Phone: 463-777-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number27070282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: