Healthcare Provider Details

I. General information

NPI: 1932580180
Provider Name (Legal Business Name): ANGELICA LEE YACKEL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELICA LEE MATTHES

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N COLLEGE ST
NORTHFIELD MN
55057-4044
US

IV. Provider business mailing address

1880 N FRONTAGE RD
HASTINGS MN
55033-2687
US

V. Phone/Fax

Practice location:
  • Phone: 507-222-4080
  • Fax:
Mailing address:
  • Phone: 651-438-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP3909
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: