Healthcare Provider Details

I. General information

NPI: 1245837640
Provider Name (Legal Business Name): ANGELA MARIE STROM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

307 CHAMBERLAIN ST
FLUSHING MI
48433-1615
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3645
  • Fax:
Mailing address:
  • Phone: 810-938-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704298210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: