Provider Demographics
NPI:1275295065
Name:DAS, ANGELA C (CLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:DAS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 STOCKBURY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9696
Mailing Address - Country:US
Mailing Address - Phone:970-219-0171
Mailing Address - Fax:
Practice Address - Street 1:2718 STOCKBURY DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9696
Practice Address - Country:US
Practice Address - Phone:970-219-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COALPP-337038174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN