Healthcare Provider Details

I. General information

NPI: 1548579618
Provider Name (Legal Business Name): ANGELA I. DEMEUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 TRILLIUM CT
MADISON WI
53719-2311
US

IV. Provider business mailing address

41 TRILLIUM CT
MADISON WI
53719-2311
US

V. Phone/Fax

Practice location:
  • Phone: 608-206-6831
  • Fax:
Mailing address:
  • Phone: 608-206-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number145254-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: