Individual
ANGELA MARIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
11900 SW GREENBURG RD, TIGARD, OR 97223-6453
(503) 620-5556
(503) 624-0118
Mailing address
11900 SW GREENBURG RD, TIGARD, OR 97223-6453
(503) 620-5556
(503) 624-0118
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00941
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00941
STATE LICENSE
OR
Enumeration date
10/27/2006
Last updated
03/07/2023
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