Provider Demographics
NPI:1487819041
Name:GAINER, ANGELA DAWN (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:GAINER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:611 N NEVADA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1099
Mailing Address - Country:US
Mailing Address - Phone:719-633-6313
Mailing Address - Fax:719-447-9262
Practice Address - Street 1:611 N NEVADA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1099
Practice Address - Country:US
Practice Address - Phone:719-633-6313
Practice Address - Fax:719-447-9262
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO411171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist