Provider Demographics
NPI:1073359329
Name:ANGLEMYER, ALISSA (FNP-C)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:ANGLEMYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EMS T15B LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-9563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2566
Practice Address - Country:US
Practice Address - Phone:918-931-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-06
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06241725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily