Healthcare Provider Details

I. General information

NPI: 1073630257
Provider Name (Legal Business Name): ANGELA MAE STOMBAUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MAE REAS NP

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GARFIELD AVE
EAU CLAIRE WI
54701-4811
US

IV. Provider business mailing address

3615 GREENDALE CT
EAU CLAIRE WI
54701-9217
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-5010
  • Fax:
Mailing address:
  • Phone: 715-832-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20040001-22
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3394
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: