Individual
JENNIFER LEE ANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
3211 N 4TH ST, SUITE A, LONGVIEW, TX 75605-5145
(903) 297-6500
(903) 297-6510
Mailing address
3211 N 4TH ST, SUITE A, LONGVIEW, TX 75605-5145
(903) 297-6500
(903) 297-6510
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
651630
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293397001
—
TX
Enumeration date
10/18/2011
Last updated
02/21/2014
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