Individual
ANGELA M BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
901 RAINIER AVE S, SEATTLE, WA 98144-2839
(206) 470-3880
Mailing address
6009 SW TAYLORS FERRY RD, PORTLAND, OR 97219-5627
(740) 398-6674
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201506660NP-PP
OR
363L00000X
Nurse Practitioner
335437
OH
363L00000X
Nurse Practitioner
Primary
AP60909585
WA
363L00000X
Nurse Practitioner
COA.13918-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500691918
—
OR
Enumeration date
08/09/2012
Last updated
01/14/2021
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