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General NPI Number Information
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NPI Number | 1194647081
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Entity Type | Individual
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Provider Name | MARY ANGERER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 1920 OLYMPIC BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-3816
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Country | US
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Telephone | 855-656-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 7809 NEW CHURCH RD
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-9670
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Country | US
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Telephone | 573-257-7247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2026036340
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License Number State | MO
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