Individual
ANGELA ELIZABETH MOENING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
4251 POWHATAN AVE, NORFOLK, VA 23508-2225
(419) 204-4187
Mailing address
705 REDGATE AVE APT 17, NORFOLK, VA 23507-1633
(419) 204-4187
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002873
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0126002873
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
12/07/2020
Last updated
12/07/2020
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