Provider Demographics
NPI:1548096696
Name:CORPORAN, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CORPORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CORPORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:152 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3218
Mailing Address - Country:US
Mailing Address - Phone:201-338-8456
Mailing Address - Fax:
Practice Address - Street 1:152 PORTER AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3218
Practice Address - Country:US
Practice Address - Phone:201-338-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421782363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty