Healthcare Provider Details

I. General information

NPI: 1578693347
Provider Name (Legal Business Name): ANGELINA C DALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

12676 JASMINE ST
THORNTON CO
80602-4666
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-7012
  • Fax:
Mailing address:
  • Phone: 720-536-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number165522
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: