Provider Demographics
NPI:1518558915
Name:NELSON, ANGELA MARIE (CPHT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:VOEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5330 ALTURAS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3407
Mailing Address - Country:US
Mailing Address - Phone:719-533-8519
Mailing Address - Fax:
Practice Address - Street 1:4142 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2928
Practice Address - Country:US
Practice Address - Phone:719-244-9783
Practice Address - Fax:719-266-0739
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10041900183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician