Provider Demographics
NPI:1144001744
Name:GYIELE, ANGELA BETIEREKE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BETIEREKE
Last Name:GYIELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LACKAWANNA ST APT 10-9
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-4232
Mailing Address - Country:US
Mailing Address - Phone:484-529-8907
Mailing Address - Fax:
Practice Address - Street 1:3985 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9003
Practice Address - Country:US
Practice Address - Phone:717-285-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant