MEDICARE: MRS. ANGELA CHRISTINE STORCK-PETERSEN MPH, MS, RD/LD, CEDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1051996	NV

General Provider Information

NPI Number	:	1346623634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA CHRISTINE STORCK-PETERSEN MPH, MS, RD/LD, CEDS

Provider Business Mailing Address
First Line	:	2109 LONE DESERT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1117
Country	:	US
Telephone Number	:	877-811-1178
Fax Number	:	877-811-1178

Provider Business Practice Location Address
First Line	:	2109 LONE DESERT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1117
Country	:	US
Telephone Number	:	877-811-1178
Fax Number	:	877-811-1178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2015
Last Update Date	:	10/24/2024

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