Healthcare Provider Details

I. General information

NPI: 1710643903
Provider Name (Legal Business Name): ANGELA MARIE NASH MSNFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 PETES PATH
AUSTIN TX
78731-6121
US

IV. Provider business mailing address

PO BOX 26631
AUSTIN TX
78755-0631
US

V. Phone/Fax

Practice location:
  • Phone: 512-228-4080
  • Fax:
Mailing address:
  • Phone: 512-228-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: