Provider Demographics
NPI:1780931725
Name:LETTIERE, ANGELINA MARIE (MA)
Entity type:Individual
Prefix:MISS
First Name:ANGELINA
Middle Name:MARIE
Last Name:LETTIERE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4919
Mailing Address - Country:US
Mailing Address - Phone:715-845-4545
Mailing Address - Fax:715-845-7426
Practice Address - Street 1:3508 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4919
Practice Address - Country:US
Practice Address - Phone:715-845-4545
Practice Address - Fax:715-845-7426
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other