Healthcare Provider Details

I. General information

NPI: 1265725030
Provider Name (Legal Business Name): ANGELA LYNN ORLANDO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

4124 TOENGES AVE
SAINT LOUIS MO
63116-2842
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax:
Mailing address:
  • Phone: 314-226-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2004020176
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: