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General NPI Number Information
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NPI Number | 1639347685
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Entity Type | Individual
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Provider Name | ANGELA KARLINA CRONIN PA
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Gender | Female
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1760 N 200 E STE 101
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City | NORTH LOGAN
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State | UT
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Zip | 84341-1202
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Country | US
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Telephone | 435-787-0560
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Fax | 435-752-4673
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Provider Business Mailing Address
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Address Line | 1550 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 208-529-5942
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA697
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License Number State | ID
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