Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP30003262 | WA |
NPI | 1033149943 |
---|---|
Provider Name | Mrs. Laura Anne Angelo |
First Address | Bellevue, WA 98005-1712 |
Second Address | Seattle, WA 98108-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD0000 | (02) | WA |