Provider Demographics
NPI:1699923748
Name:ROSS, ANGELA FAY (BS, MSPAS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAY
Last Name:ROSS
Suffix:
Gender:F
Credentials:BS, MSPAS
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:FAY
Other - Last Name:HUENINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:STE 355
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1252
Mailing Address - Country:US
Mailing Address - Phone:317-924-8425
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:1801 N. SENATE BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1252
Practice Address - Country:US
Practice Address - Phone:317-924-8425
Practice Address - Fax:317-924-8424
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001019A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN076330001Medicare PIN
IN165460D8Medicare PIN