Provider Demographics
NPI:1205966132
Name:JAEGGLI, ANGILA MELISANDE (ND)
Entity type:Individual
Prefix:DR
First Name:ANGILA
Middle Name:MELISANDE
Last Name:JAEGGLI
Suffix:
Gender:F
Credentials:ND
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Mailing Address - Street 1:1617 S MERCER ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3912
Mailing Address - Country:US
Mailing Address - Phone:206-854-8829
Mailing Address - Fax:509-335-7227
Practice Address - Street 1:1610 NE EASTGATE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5609
Practice Address - Country:US
Practice Address - Phone:509-432-4301
Practice Address - Fax:509-335-7227
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WANT00001428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine