Healthcare Provider Details

I. General information

NPI: 1538461645
Provider Name (Legal Business Name): ANGELENA LYNN OREAR FNP-
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S PARK ST
EL DORADO SPRINGS MO
64744-2037
US

IV. Provider business mailing address

RR 1 BOX 38A ROAD 11517
HUME MO
64752-9720
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-2511
  • Fax:
Mailing address:
  • Phone: 660-832-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2010034958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: