Provider Demographics
NPI:1750135810
Name:ANGEL, MISTY DAWN
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:ANGEL
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:BROWINKANDCO7@GMAIL.COM
Mailing Address - Street 2:PO BOX 961
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130
Mailing Address - Country:US
Mailing Address - Phone:304-601-3803
Mailing Address - Fax:
Practice Address - Street 1:1522 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2442
Practice Address - Country:US
Practice Address - Phone:304-601-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty