Provider Demographics
NPI:1427302405
Name:GARD, ANGELA JEAN (RN, BSN, APN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:GARD
Suffix:
Gender:F
Credentials:RN, BSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 W 857 N
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46349-9521
Mailing Address - Country:US
Mailing Address - Phone:219-992-9148
Mailing Address - Fax:
Practice Address - Street 1:17648 MORSE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1420
Practice Address - Country:US
Practice Address - Phone:219-696-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004206A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily