Individual
ANGELA WYBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2725 MENDOCINO AVE, SANTA ROSA, CA 95403-2805
(707) 545-4537
(707) 545-6726
Mailing address
2725 MENDOCINO AVE, SANTA ROSA, CA 95403-2805
(707) 545-4537
(707) 545-6726
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871588715
—
CA
01
—
P01795158
RAILROAD MEDICARE
CA
Enumeration date
09/16/2005
Last updated
04/13/2022
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