Healthcare Provider Details

I. General information

NPI: 1598649915
Provider Name (Legal Business Name): ANGELA MCCORMICK HEALTH COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 D HAWK CIR
THOREAU NM
87323
US

IV. Provider business mailing address

PO BOX 813
THOREAU NM
87323-0813
US

V. Phone/Fax

Practice location:
  • Phone: 717-510-4785
  • Fax:
Mailing address:
  • Phone: 717-510-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: