Provider Demographics
NPI:1528495991
Name:RAFFERTY, ANGELA C (ILI)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:C
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:ILI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W CHICAGO ST
Mailing Address - Street 2:APT #13
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8411
Mailing Address - Country:US
Mailing Address - Phone:517-279-8423
Mailing Address - Fax:517-279-0664
Practice Address - Street 1:528 W CHICAGO ST
Practice Address - Street 2:APT #13
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8411
Practice Address - Country:US
Practice Address - Phone:517-279-8423
Practice Address - Fax:517-279-0664
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist