Healthcare Provider Details

I. General information

NPI: 1841389517
Provider Name (Legal Business Name): ANGELA JEANETTE COLLINS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA JEANETTE CASTEEL DO

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 C ST UNIT 110
WASHOUGAL WA
98671-2168
US

IV. Provider business mailing address

PO BOX 4825
PORTLAND OR
97208-4825
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1644
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4347
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61072319
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007008847
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: