Provider Demographics
NPI:1306144704
Name:CROUSE, ANGELA JANE (NP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JANE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:JANE
Other - Last Name:GRIMALDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1200 W WHITE RIVER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3400
Practice Address - Country:US
Practice Address - Phone:765-281-2000
Practice Address - Fax:765-281-2062
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003561A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201012750Medicaid
INP00954938OtherRR MEDICARE
IN201012750Medicaid