Healthcare Provider Details

I. General information

NPI: 1598699738
Provider Name (Legal Business Name): ANGELA BOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 S 83RD ST APT 5
LA VISTA NE
68128-4813
US

IV. Provider business mailing address

7005 S 83RD ST APT 5
LA VISTA NE
68128-4813
US

V. Phone/Fax

Practice location:
  • Phone: 404-918-8762
  • Fax:
Mailing address:
  • Phone: 404-918-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: