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General NPI Number Information
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NPI Number | 1205966132
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Entity Type | Individual
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Provider Name | ANGILA MELISANDE JAEGGLI N.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1610 NE EASTGATE BLVD STE 250
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City | PULLMAN
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State | WA
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Zip | 99163-5609
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Country | US
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Telephone | 509-432-4301
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Fax | 509-335-7227
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Provider Business Mailing Address
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Address Line | 1617 S MERCER ST
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City | MOSCOW
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State | ID
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Zip | 83843-3912
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Country | US
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Telephone | 206-854-8829
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Fax | 509-335-7227
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NT00001428
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License Number State | WA
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