Provider Demographics
NPI:1861775389
Name:WALISZEWSKI, ANGELA DAY (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAY
Last Name:WALISZEWSKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 GRAND OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4490
Mailing Address - Country:US
Mailing Address - Phone:719-510-8120
Mailing Address - Fax:
Practice Address - Street 1:1732 GRAND OVERLOOK ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-4490
Practice Address - Country:US
Practice Address - Phone:719-510-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002727133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861775389Medicare PIN