Provider Demographics
NPI:1992318141
Name:ANGELES, MARY JUCEL P (CRNP)
Entity type:Individual
Prefix:
First Name:MARY JUCEL
Middle Name:P
Last Name:ANGELES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY JUCEL
Other - Middle Name:
Other - Last Name:DELACALZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 467
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3434
Mailing Address - Country:US
Mailing Address - Phone:610-896-7424
Mailing Address - Fax:610-896-6171
Practice Address - Street 1:100 E LANCASTER AVE STE 467
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3434
Practice Address - Country:US
Practice Address - Phone:610-896-7424
Practice Address - Fax:610-896-6171
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner