Healthcare Provider Details

I. General information

NPI: 1699764001
Provider Name (Legal Business Name): LUCINDA ANN ANGYAL WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 CANNON ST SE
SALEM OR
97302-2548
US

IV. Provider business mailing address

1655 HILLWOOD CT S
SALEM OR
97302-3621
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-7525
  • Fax: 503-588-7525
Mailing address:
  • Phone: 503-391-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000031049N7
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: