Individual
ANGELA NAOMI LYBBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4270 S DECATUR BLVD STE B5, LAS VEGAS, NV 89103-6802
(725) 220-4200
(725) 220-4199
Mailing address
9325 RAM CLIFFS PL, LAS VEGAS, NV 89178-3533
(702) 278-9135
(888) 384-5951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA685
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002402137
—
NV
05
—
100510051
—
NV
01
—
CC9894
ANTHEM BCBS NV
NV
01
—
NV1360
ANTHEM BCBS NV GROUP
NV
01
—
V103699
NV MEDICARE PTAN
NV
Enumeration date
08/31/2006
Last updated
05/06/2020
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