Provider Demographics
NPI:1154043040
Name:VANDERKARR, ANGELA JOAN (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOAN
Last Name:VANDERKARR
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 1:234 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9203
Mailing Address - Country:US
Mailing Address - Phone:989-275-1200
Mailing Address - Fax:
Practice Address - Street 1:234 LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9203
Practice Address - Country:US
Practice Address - Phone:989-275-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704342988OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS