Healthcare Provider Details

I. General information

NPI: 1740146448
Provider Name (Legal Business Name): ANGELA RAE BARRIBEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W JEFFERSON AVE
FALL CREEK WI
54742-9790
US

IV. Provider business mailing address

430 W JEFFERSON AVE
FALL CREEK WI
54742-9790
US

V. Phone/Fax

Practice location:
  • Phone: 715-579-4407
  • Fax:
Mailing address:
  • Phone: 715-579-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number5150-142
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: