1043404429 NPI number — ANGELA SCHWEER-WILT

Table of content: ANGELA SCHWEER-WILT (NPI 1043404429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043404429 NPI number — ANGELA SCHWEER-WILT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWEER-WILT
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1043404429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 357279
Provider Second Line Business Mailing Address:
SUITE 1200 W
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32635-7279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-224-1962
Provider Business Mailing Address Fax Number:
352-224-1965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 PEORIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80010-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-340-3053
Provider Business Practice Location Address Fax Number:
303-340-3862
Provider Enumeration Date:
08/29/2007

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: 225100000X , with the licence number:  9709 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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