Healthcare Provider Details

I. General information

NPI: 1568962355
Provider Name (Legal Business Name): ANGELA MARIE BARTLETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2018
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD STE 20
DAYTON OH
45414-5803
US

IV. Provider business mailing address

4160 LITTLE YORK RD STE 20
DAYTON OH
45414-5803
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax:
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number399434
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number022183
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: