Healthcare Provider Details

I. General information

NPI: 1417657875
Provider Name (Legal Business Name): ANGELA LYNN CHANDLER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA LYNN KOZLOWSKI

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 JEFFCO BLVD
ARNOLD MO
63010-2138
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 636-321-8610
  • Fax:
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022049214
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022049214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: