Provider Demographics
NPI:1447727896
Name:ERXLEBEN, ANGELA LYNN (ND)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:ERXLEBEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W LA JOLLA DR APT 1048
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4451
Mailing Address - Country:US
Mailing Address - Phone:308-750-0709
Mailing Address - Fax:
Practice Address - Street 1:1600 W LA JOLLA DR
Practice Address - Street 2:#1048
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4451
Practice Address - Country:US
Practice Address - Phone:308-750-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1617175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath