Healthcare Provider Details

I. General information

NPI: 1902262389
Provider Name (Legal Business Name): ANGELA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 EDGEWATER AVE
CHEYENNE WY
82009-7311
US

IV. Provider business mailing address

1805 EDGEWATER AVE
CHEYENNE WY
82009-7311
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-3624
  • Fax:
Mailing address:
  • Phone: 307-274-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: