Healthcare Provider Details

I. General information

NPI: 1366825820
Provider Name (Legal Business Name): ANGELA PORCELLI APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MENOS APNP

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/08/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S MADISON ST
APPLETON WI
54915-1844
US

IV. Provider business mailing address

2500 E CAPITOL DR STE 1700
APPLETON WI
54911-8735
US

V. Phone/Fax

Practice location:
  • Phone: 920-730-5380
  • Fax:
Mailing address:
  • Phone: 920-734-9600
  • Fax: 920-734-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6434-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6434-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: