MEDICARE: ANGELA SMOTHERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APN.1000798	CO

General Provider Information

NPI Number	:	1477129625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SMOTHERMAN

Provider Business Mailing Address
First Line	:	1495 GARDEN OF THE GODS RD STE 102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3429
Country	:	US
Telephone Number	:	719-339-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 GARDEN OF THE GODS RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9444
Country	:	US
Telephone Number	:	719-339-4129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	02/17/2026

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