Provider Demographics
NPI:1104096064
Name:OHNESORGE, ANGELA NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NICOLE
Last Name:OHNESORGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N167W21209 SCOT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-9316
Mailing Address - Country:US
Mailing Address - Phone:262-677-2453
Mailing Address - Fax:
Practice Address - Street 1:N167W21209 SCOT CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9316
Practice Address - Country:US
Practice Address - Phone:262-677-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
39931900OtherPROVIDER ID