Basic Information
| Provider Information | |||||||||
| NPI: | 1760463988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWDESHELL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | IMPERIAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IMPERIAL | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | ENRIQUE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1005 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820031005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076349653 | ||||||||
| FaxNumber: | 3076388256 | ||||||||
| Practice Location | |||||||||
| Address1: | 1263 N 15TH ST | ||||||||
| Address2: | PEAK WELLNESS CENTER- ALBANY BRANCH | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820722343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077458915 | ||||||||
| FaxNumber: | 3077458761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | WY2103A | WY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 0798 | SD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 305054 | 01 | WY | BS | OTHER |