Provider Demographics
NPI:1437764453
Name:GIDDINGS, ANGELA (DAOM)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:KELSEY-GIDDINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAOM
Mailing Address - Street 1:205 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-0946
Mailing Address - Country:US
Mailing Address - Phone:612-423-9511
Mailing Address - Fax:
Practice Address - Street 1:109 S 65TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3408
Practice Address - Country:US
Practice Address - Phone:360-559-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61087581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist