Provider Demographics
NPI:1801985841
Name:STAAB, ANGELA (ANP GNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:STAAB
Suffix:
Gender:F
Credentials:ANP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 NC HWY 65
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27375
Mailing Address - Country:US
Mailing Address - Phone:336-342-8216
Mailing Address - Fax:336-342-8128
Practice Address - Street 1:371 NC HWY 65
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27375
Practice Address - Country:US
Practice Address - Phone:336-342-8216
Practice Address - Fax:336-342-8128
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900005363LF0000X, 363LX0001X, 363LW0102X, 363LP0200X, 363LA2200X, 363LP2300X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC58220OtherREGISTRATION NUMBER
NC900005OtherLICENSE