Provider Demographics
NPI:1588757629
Name:PRUDEN, ANGELA M (MD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1400 N 9TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2499
Mailing Address - Country:US
Mailing Address - Phone:402-370-1400
Mailing Address - Fax:402-685-2885
Practice Address - Street 1:1400 N 9TH ST STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2499
Practice Address - Country:US
Practice Address - Phone:402-370-1400
Practice Address - Fax:402-685-2885
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE22631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI32788Medicare UPIN
NENA1959011Medicare PIN