Healthcare Provider Details

I. General information

NPI: 1053046805
Provider Name (Legal Business Name): ANGELA WEN GATES APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 03/29/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST
LONDON OH
43140-1115
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 740-845-7700
  • Fax: 740-845-7701
Mailing address:
  • Phone: 740-845-7700
  • Fax: 740-845-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0031779
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0031779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: