Provider Demographics
NPI:1770159097
Name:MERWIN, ANGELA (RDN, LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MERWIN
Suffix:
Gender:F
Credentials:RDN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 SE GRAY RD
Mailing Address - Street 2:
Mailing Address - City:ROSALIA
Mailing Address - State:KS
Mailing Address - Zip Code:67132-9105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3645
Practice Address - Country:US
Practice Address - Phone:316-260-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04699101Y00000X
KS2316133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101Y00000XBehavioral Health & Social Service ProvidersCounselor