Provider Demographics
NPI:1780191072
Name:FREYERMUTH, ANGELA KAY
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:FREYERMUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 67TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-1119
Mailing Address - Country:US
Mailing Address - Phone:563-260-0981
Mailing Address - Fax:
Practice Address - Street 1:312 IOWA AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3836
Practice Address - Country:US
Practice Address - Phone:563-260-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator