Provider Demographics
NPI:1700067725
Name:CLEVENGER, ANGELA R (CFNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:HINDBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-7578
Mailing Address - Fax:217-545-1884
Practice Address - Street 1:612 N 11TH ST
Practice Address - Street 2:STE B
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2662
Practice Address - Country:US
Practice Address - Phone:217-224-9484
Practice Address - Fax:217-224-7950
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46703Medicare PIN