Provider Demographics
NPI:1023530110
Name:PHARES, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PHARES
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 1:178 PRIVATE ROAD 19423
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8831
Mailing Address - Country:US
Mailing Address - Phone:740-263-2626
Mailing Address - Fax:740-894-1132
Practice Address - Street 1:178 PRIVATE ROAD 19423
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-8831
Practice Address - Country:US
Practice Address - Phone:740-263-2626
Practice Address - Fax:740-894-1132
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH440126363LF0000X
WVAPRN70618NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily