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Individual

MRS. ANGELA RACHELLE MIEDEMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
150 IVEY LN STE A, PINEHURST, NC 28374-9817
(910) 215-5200
Mailing address
PO BOX 896208, CHARLOTTE, NC 28289-6208
(910) 715-1010

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09633
NC
363A00000X
Physician Assistant
10001954A
IN

Other

Enumeration date
01/01/2016
Last updated
01/28/2020
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