Healthcare Provider Details

I. General information

NPI: 1891888624
Provider Name (Legal Business Name): ANGELA MAYO HINNENKAMP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 FLEMING ST
HENDERSONVILLE NC
28791-3573
US

IV. Provider business mailing address

1027 FLEMING ST
HENDERSONVILLE NC
28791-3573
US

V. Phone/Fax

Practice location:
  • Phone: 828-696-3099
  • Fax: 828-696-3868
Mailing address:
  • Phone: 828-692-5781
  • Fax: 828-696-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001000160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: