Provider Demographics
NPI:1881161438
Name:SMUTEK, ANGELA (HNWP, CFNS)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:SMUTEK
Suffix:
Gender:F
Credentials:HNWP, CFNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3944
Mailing Address - Country:US
Mailing Address - Phone:602-499-3243
Mailing Address - Fax:
Practice Address - Street 1:10621 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3944
Practice Address - Country:US
Practice Address - Phone:602-499-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1190336148133NN1002X, 171400000X
AZ133NN1002X, 174H00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator