Basic Information
Provider Information
NPI: 1609861749
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ATZEN
FirstName: ANGELIA
MiddleName: RENEE
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7147 VISTA DR STE 150
Address2:  
City: WEST DES MOINES
State: IA
PostalCode: 502669313
CountryCode: US
TelephoneNumber: 5158759925
FaxNumber: 5158759923
Practice Location
Address1: 160 ADVENTURELAND DR NW
Address2: STE C
City: ALTOONA
State: IA
PostalCode: 50009
CountryCode: US
TelephoneNumber: 5158759020
FaxNumber: 5158759021
Other Information
ProviderEnumerationDate: 09/14/2005
LastUpdateDate: 06/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDO-03475IAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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