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NPI Code Detail

MEDICARE: MRS. ANGELA SEWELL RADER FNP

MEDICARE:  MRS. ANGELA SEWELL RADER  FNP
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
1363L00000XNurse PractitionerAPN 12619TN

General Provider Information

NPI Number : 1407056328
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA SEWELL RADER FNP
Provider Business Mailing Address
First Line : 300 MED TECH PKWY
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2277
Country : US
Telephone Number : 423-302-1200
Fax Number :
Provider Business Practice Location Address
First Line : 300 MED TECH PKWY
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2277
Country : US
Telephone Number : 423-302-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2007
Last Update Date : 10/24/2011

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Directions to “ MRS. ANGELA SEWELL RADER FNP” Practice Location

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