Healthcare Provider Details

I. General information

NPI: 1871743906
Provider Name (Legal Business Name): ANGELA MARIE MATHIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 19TH AVE E
SEATTLE WA
98112-4007
US

IV. Provider business mailing address

1605 E OLIVE ST APT. 207
SEATTLE WA
98122-2757
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1600
  • Fax:
Mailing address:
  • Phone: 206-568-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60045367
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN00155045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: