Healthcare Provider Details

I. General information

NPI: 1801907621
Provider Name (Legal Business Name): ANGELA NAOMI LYBBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 S DECATUR BLVD STE B5
LAS VEGAS NV
89103-6802
US

IV. Provider business mailing address

9325 RAM CLIFFS PL
LAS VEGAS NV
89178-3533
US

V. Phone/Fax

Practice location:
  • Phone: 725-220-4200
  • Fax: 725-220-4199
Mailing address:
  • Phone: 702-278-9135
  • Fax: 888-384-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA685
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: