Provider Demographics
NPI:1265805535
Name:JAKAB-MILLER, ANGELA (MA60592340)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:JAKAB-MILLER
Suffix:
Gender:F
Credentials:MA60592340
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 129TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-5405
Mailing Address - Country:US
Mailing Address - Phone:321-848-8465
Mailing Address - Fax:
Practice Address - Street 1:554 129TH AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-5405
Practice Address - Country:US
Practice Address - Phone:321-848-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-08
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60592340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist