Healthcare Provider Details

I. General information

NPI: 1629946835
Provider Name (Legal Business Name): ANGELA HOMMERDING
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E CAPITOL DR
APPLETON WI
54911-8735
US

IV. Provider business mailing address

1083 PENDLETON PKWY UNIT 114
NEENAH WI
54956-6441
US

V. Phone/Fax

Practice location:
  • Phone: 920-364-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14128-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14128-40
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14128-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: