Provider Demographics
NPI:1801417647
Name:WEBER, ANGELA JEAN (DCM)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JEAN
Last Name:WEBER
Suffix:
Gender:F
Credentials:DCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9300
Mailing Address - Country:US
Mailing Address - Phone:952-222-8158
Mailing Address - Fax:
Practice Address - Street 1:1611 W WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9300
Practice Address - Country:US
Practice Address - Phone:952-222-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist