Healthcare Provider Details

I. General information

NPI: 1104888627
Provider Name (Legal Business Name): ANGELA JEAN MAJERES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

IV. Provider business mailing address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5890
  • Fax: 833-918-2049
Mailing address:
  • Phone: 605-331-5890
  • Fax: 833-918-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0609
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: