Provider Demographics
NPI:1902557440
Name:MAXSON, ANGELA K (OMS-4)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:MAXSON
Suffix:
Gender:F
Credentials:OMS-4
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:K
Other - Last Name:MAXSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OMS-4
Mailing Address - Street 1:809 WHITE BLUFFS PL
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9406
Mailing Address - Country:US
Mailing Address - Phone:406-437-8490
Mailing Address - Fax:
Practice Address - Street 1:809 WHITE BLUFFS PL
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-9406
Practice Address - Country:US
Practice Address - Phone:406-437-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program