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NPI Code Detail

MEDICARE: ANGIE LEA-WILSON FNP-C

MEDICARE: ANGIE LEA-WILSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95030562CA

General Provider Information

NPI Number : 1265252258
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE LEA-WILSON FNP-C
Provider Business Mailing Address
First Line : 18080 IMPERIAL HWY
Second Line :
City : YORBA LINDA
State : CA
Zip : 92886-3436
Country : US
Telephone Number : 714-961-1054
Fax Number :
Provider Business Practice Location Address
First Line : 1401 S BALDWIN AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-7922
Country : US
Telephone Number : 626-445-1284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2024
Last Update Date : 02/08/2026

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