Individual
ANGELA M NORTHCUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
123 S FRANKLIN RD, BLOOMINGTON, IN 47404-5296
(812) 778-3116
(812) 778-3117
Mailing address
123 S FRANKLIN RD, BLOOMINGTON, IN 47404-5296
(812) 778-3116
(812) 778-3117
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10003396A
IN
363AS0400X
Surgical Physician Assistant
1612-023
WV
363AS0400X
Surgical Physician Assistant
9948
MN
363AS0400X
Surgical Physician Assistant
PA04880
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42865500
—
WI
05
—
559168600
—
MN
01
—
8N9563
BLUE CROSS BLUE SHIELD OF
TX
Enumeration date
06/30/2005
Last updated
01/11/2023
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