Provider Demographics
NPI:1235573627
Name:DORNBURGH, ANGELA LYNN (CLC,LCCE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:DORNBURGH
Suffix:
Gender:F
Credentials:CLC,LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ALLARD RD
Mailing Address - Street 2:
Mailing Address - City:WHITINGHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05361-4600
Mailing Address - Country:US
Mailing Address - Phone:802-368-0072
Mailing Address - Fax:
Practice Address - Street 1:14 ALLARD RD
Practice Address - Street 2:
Practice Address - City:WHITINGHAM
Practice Address - State:VT
Practice Address - Zip Code:05361-4600
Practice Address - Country:US
Practice Address - Phone:802-368-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula