Provider Demographics
NPI:1619248952
Name:WELBORN, ANGELA SUE (CMII)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUE
Last Name:WELBORN
Suffix:
Gender:F
Credentials:CMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7400
Mailing Address - Country:US
Mailing Address - Phone:580-916-1358
Mailing Address - Fax:580-924-0972
Practice Address - Street 1:715 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3801
Practice Address - Country:US
Practice Address - Phone:580-931-3008
Practice Address - Fax:580-931-8022
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator