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General NPI Number Information
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NPI Number | 1447507462
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Entity Type | Individual
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Provider Name | ANGELA M BLACK C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 901 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98144-2839
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Country | US
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Telephone | 206-470-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 6009 SW TAYLORS FERRY RD
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City | PORTLAND
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State | OR
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Zip | 97219-5627
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Country | US
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Telephone | 740-398-6674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA.13918-NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201506660NP-PP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60909585
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 335437
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License Number State | OH
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