Healthcare Provider Details

I. General information

NPI: 1174998868
Provider Name (Legal Business Name): ANGELA WIRSCHING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 12/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 W 28TH ST APT 68
GREELEY CO
80634-7833
US

IV. Provider business mailing address

2837 W 28TH ST APT 68
GREELEY CO
80634-7833
US

V. Phone/Fax

Practice location:
  • Phone: 719-659-1563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: