Provider Demographics
NPI:1851502785
Name:FELTZ, ANGELA SMITH (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SMITH
Last Name:FELTZ
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 1:1161 QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5919
Mailing Address - Country:US
Mailing Address - Phone:248-969-0032
Mailing Address - Fax:
Practice Address - Street 1:1100 TORREY RD
Practice Address - Street 2:300
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3327
Practice Address - Country:US
Practice Address - Phone:810-714-7369
Practice Address - Fax:810-714-9258
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356618328Medicaid
MI5008614480OtherBCBS IND
MIMI3292020Medicare PIN