Provider Demographics
NPI:1346432036
Name:POWELL, ANGELA J (RD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 BROADMOOR BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8204
Mailing Address - Country:US
Mailing Address - Phone:719-660-2677
Mailing Address - Fax:
Practice Address - Street 1:4920 BROADMOOR BLUFFS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8204
Practice Address - Country:US
Practice Address - Phone:719-434-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT06553OtherLICENSURE