Healthcare Provider Details

I. General information

NPI: 1902232879
Provider Name (Legal Business Name): ANGELA TIEDE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA GOODSON

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 206-520-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60235945
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60410240
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: