Provider Demographics
NPI:1801207295
Name:NIBLETT, ANGELLA ANN
Entity Type:Individual
Prefix:MRS
First Name:ANGELLA
Middle Name:ANN
Last Name:NIBLETT
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 1:13141 132ND ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6212
Mailing Address - Country:US
Mailing Address - Phone:715-829-0928
Mailing Address - Fax:
Practice Address - Street 1:13141 132ND ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6212
Practice Address - Country:US
Practice Address - Phone:715-829-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2170-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant