Healthcare Provider Details

I. General information

NPI: 1144025305
Provider Name (Legal Business Name): ANGIE NEMELKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 MCCOURTNEY RD
GRASS VALLEY CA
95949-7400
US

IV. Provider business mailing address

988 MCCOURTNEY RD
GRASS VALLEY CA
95949-7400
US

V. Phone/Fax

Practice location:
  • Phone: 530-470-2736
  • Fax:
Mailing address:
  • Phone: 530-470-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: