1760463988 NPI number — DR. ANGELA IMPERIAL HOWDESHELL MD

Table of content: DR. ANGELA IMPERIAL HOWDESHELL MD (NPI 1760463988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760463988 NPI number — DR. ANGELA IMPERIAL HOWDESHELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWDESHELL
Provider First Name:
ANGELA
Provider Middle Name:
IMPERIAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IMPERIAL
Provider Other First Name:
ANGELA
Provider Other Middle Name:
ENRIQUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760463988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82003-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-634-9653
Provider Business Mailing Address Fax Number:
307-638-8256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1263 N 15TH ST
Provider Second Line Business Practice Location Address:
PEAK WELLNESS CENTER- ALBANY BRANCH
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82072-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-745-8915
Provider Business Practice Location Address Fax Number:
307-745-8761
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  WY2103A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 0798 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 305054 . This is a "BS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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