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General NPI Number Information
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NPI Number | 1417061821
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Entity Type | Individual
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Provider Name | ANGELINA KELLY VISCARDI WALLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 11960 LIONESS WAY STE 260
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City | PARKER
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State | CO
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Zip | 80134
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Country | US
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Telephone | 303-344-9090
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Fax | 720-895-1121
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Provider Business Mailing Address
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Address Line | 8101 E LOWRY BLVD STE 230
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City | DENVER
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State | CO
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Zip | 80230-7195
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Country | US
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Telephone | 303-344-9090
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Fax | 303-344-1922
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2178
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2178
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License Number State | CO
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