Provider Demographics
NPI:1659451987
Name:LONDON, ANGELA SUSAN (ND)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUSAN
Last Name:LONDON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8605
Mailing Address - Country:US
Mailing Address - Phone:360-384-2900
Mailing Address - Fax:360-384-2955
Practice Address - Street 1:2376 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8605
Practice Address - Country:US
Practice Address - Phone:360-384-2900
Practice Address - Fax:360-384-2955
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath