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General NPI Number Information
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NPI Number | 1801907621
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Entity Type | Individual
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Provider Name | ANGELA NAOMI LYBBERT PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 4270 S DECATUR BLVD STE B5
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City | LAS VEGAS
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State | NV
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Zip | 89103-6802
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Country | US
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Telephone | 725-220-4200
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Fax | 725-220-4199
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Provider Business Mailing Address
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Address Line | 9325 RAM CLIFFS PL
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City | LAS VEGAS
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State | NV
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Zip | 89178-3533
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Country | US
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Telephone | 702-278-9135
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Fax | 888-384-5951
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA685
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License Number State | NV
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