Provider Demographics
NPI:1346623634
Name:STORCK-PETERSEN, ANGELA CHRISTINE (MPH, MS, RD/LD, CEDS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:STORCK-PETERSEN
Suffix:
Gender:F
Credentials:MPH, MS, RD/LD, CEDS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:HARVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2109 LONE DESERT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1117
Mailing Address - Country:US
Mailing Address - Phone:877-811-1178
Mailing Address - Fax:877-811-1178
Practice Address - Street 1:2109 LONE DESERT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1117
Practice Address - Country:US
Practice Address - Phone:877-811-1178
Practice Address - Fax:877-811-1178
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1051996133V00000X
CA1051996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered