1033385638 NPI number — ANGELA DAWN CHEVALIER NELSON MA FAAA

Table of content: ANGELA DAWN CHEVALIER NELSON MA FAAA (NPI 1033385638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033385638 NPI number — ANGELA DAWN CHEVALIER NELSON MA FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
ANGELA
Provider Middle Name:
DAWN CHEVALIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033385638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4418 VINELAND AVE
Provider Second Line Business Mailing Address:
SUITE 123
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91602-3457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-985-8180
Provider Business Mailing Address Fax Number:
818-763-1809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4418 VINELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-985-8180
Provider Business Practice Location Address Fax Number:
818-763-1809
Provider Enumeration Date:
05/02/2008

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: 231H00000X , with the licence number:  AU2202 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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