Healthcare Provider Details

I. General information

NPI: 1831805464
Provider Name (Legal Business Name): ANGELA WAGAMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA WEIS RN

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH STREET 2A SPECIALTY CLINIC
DES MOINES IA
50310
US

IV. Provider business mailing address

3912 DOUGLAS AVE
DES MOINES IA
50310-3654
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax: 515-699-5449
Mailing address:
  • Phone: 515-419-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number118418
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: