Healthcare Provider Details

I. General information

NPI: 1740783877
Provider Name (Legal Business Name): DYLAN ANGUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E HASKELL ST
WINNEMUCCA NV
89445-3247
US

IV. Provider business mailing address

118 E HASKELL ST
WINNEMUCCA NV
89445-3247
US

V. Phone/Fax

Practice location:
  • Phone: 775-623-5222
  • Fax:
Mailing address:
  • Phone: 775-623-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number71227
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: