Healthcare Provider Details

I. General information

NPI: 1356766737
Provider Name (Legal Business Name): ANGELA MICHELLE BARTLETT BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 MAPLE ST
FARMINGTON MO
63640-1955
US

IV. Provider business mailing address

1085 MAPLE ST
FARMINGTON MO
63640-1955
US

V. Phone/Fax

Practice location:
  • Phone: 573-747-2435
  • Fax:
Mailing address:
  • Phone: 573-747-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number127041 B
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: