Healthcare Provider Details

I. General information

NPI: 1205278181
Provider Name (Legal Business Name): ANGELICA LYNN NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELICA LYNN NEWMAN

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 4TH ST
REDMOND OR
97756
US

IV. Provider business mailing address

1913 SW 41ST LANE
REDMOND OR
97756
US

V. Phone/Fax

Practice location:
  • Phone: 541-824-0733
  • Fax:
Mailing address:
  • Phone: 209-631-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC10222
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: