Healthcare Provider Details

I. General information

NPI: 1689147555
Provider Name (Legal Business Name): ANGELA C SLOAN CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ARAPAHOE AVE
BOULDER CO
80303-1131
US

IV. Provider business mailing address

461 LEON LN
THORNTON CO
80260
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7000
  • Fax:
Mailing address:
  • Phone: 601-697-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number179989
License Number StateMS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier83-2977037
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerSURGICAL FIRST ASSISTING

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: