Healthcare Provider Details

I. General information

NPI: 1982152393
Provider Name (Legal Business Name): ANGELA SUE ST. ONGE AGPCNP-BC. BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 CHANDLER DR
SPOONER WI
54801-2204
US

IV. Provider business mailing address

1180 CHANDLER DRIVE ESSENTIA HEALTH SPOONER CLINIC
SPOONER WI
54801-2204
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-2151
  • Fax:
Mailing address:
  • Phone: 715-635-2151
  • Fax: 715-635-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7847-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number7847-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number156262-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: