Individual
ANGELA RENEE YORK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2099
(541) 267-5151
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
102436
CO
363L00000X
Nurse Practitioner
Primary
201150055NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC-MAIN GROUP NPI
OR
01
—
161133
NBMC-MAIN GROUP DMAP
OR
05
—
39234355
—
CO
05
—
500635199
—
OR
01
—
93-0635514
NBMC-MAIN GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC-MAIN GROUP MEDICARE
OR
Enumeration date
06/18/2006
Last updated
11/04/2020
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