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NPI Code Detail

MEDICARE: ANGELA KASBOHM L.D.

MEDICARE: ANGELA KASBOHM L.D.
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
1133V00000XRegistered Dietitian1068OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11068OTHEROKLD LICENSE

General Provider Information

NPI Number : 1861572505
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA KASBOHM L.D.
Provider Business Mailing Address
First Line : 2115 PARKVIEW DR
Second Line :
City : EL RENO
State : OK
Zip : 73036-2109
Country : US
Telephone Number : 405-262-2640
Fax Number : 405-422-2521
Provider Business Practice Location Address
First Line : 2115 PARKVIEW DR
Second Line :
City : EL RENO
State : OK
Zip : 73036-2109
Country : US
Telephone Number : 405-262-2640
Fax Number : 405-422-2521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 10/27/2011

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Directions to “ ANGELA KASBOHM L.D.” Practice Location

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