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General NPI Number Information
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NPI Number | 1528434222
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Entity Type | Individual
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Provider Name | ANGELA L KING FNP
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 2905 N MAIN ST
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City | DECATUR
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State | IL
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Zip | 62526-4274
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Country | US
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Telephone | 217-877-9117
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Fax | 217-877-3081
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Provider Business Mailing Address
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Address Line | 4731 BARBERRY CT
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City | DECATUR
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State | IL
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Zip | 62526-9329
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Country | US
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Telephone | 217-791-2003
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209013099
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License Number State | IL
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