Provider Demographics
NPI:1467870485
Name:WIVODA, ANGELA (CRTS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WIVODA
Suffix:
Gender:F
Credentials:CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E HOWARD ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1772
Mailing Address - Country:US
Mailing Address - Phone:218-208-2578
Mailing Address - Fax:
Practice Address - Street 1:302 EAST HOWARD STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-208-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171WH0202XOther Service ProvidersContractorHome Modifications