Provider Demographics
NPI:1679748818
Name:WILLIAMS, ANGIE (CSFA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0673
Mailing Address - Country:US
Mailing Address - Phone:719-457-6200
Mailing Address - Fax:
Practice Address - Street 1:19250 SIXPENNY LN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-2851
Practice Address - Country:US
Practice Address - Phone:719-457-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001148246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant