Healthcare Provider Details

I. General information

NPI: 1306968433
Provider Name (Legal Business Name): ANGELA R. CUPPLES MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 PIPER STREET SUITE LL139
ANCHORAGE AK
99504
US

IV. Provider business mailing address

PO BOX 196276
ANCHORAGE AK
99519-6276
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-6233
  • Fax: 907-563-3217
Mailing address:
  • Phone: 907-565-6522
  • Fax: 907-565-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: