Provider Demographics
NPI:1871533166
Name:REED, ANGELA (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:803 W ARLINGTON ST
Mailing Address - Street 2:BANGOR HEALTH CENTER
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1108
Mailing Address - Country:US
Mailing Address - Phone:269-427-6810
Mailing Address - Fax:269-427-6811
Practice Address - Street 1:803 W ARLINGTON ST
Practice Address - Street 2:BANGOR HEALTH CENTER
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1108
Practice Address - Country:US
Practice Address - Phone:269-427-6810
Practice Address - Fax:269-427-6811
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704182710363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4826733Medicaid