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NPI Code Detail

MEDICARE: ANGELA RENEE YORK N.P.

MEDICARE: ANGELA RENEE YORK N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner102436CO
2363L00000XNurse Practitioner201150055NPOR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5R0000WFBTVOTHERORNBMC-MAIN GROUP MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11407812365OTHERORNBMC-MAIN GROUP NPI
293-0635514OTHERORNBMC-MAIN GROUP TAX ID FOR BILLING
3161133OTHERORNBMC-MAIN GROUP DMAP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063457612
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA RENEE YORK N.P.
Provider Business Mailing Address
First Line : 1900 WOODLAND DR
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2099
Country : US
Telephone Number : 541-267-5151
Fax Number :
Provider Business Practice Location Address
First Line : 1900 WOODLAND DR
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2099
Country : US
Telephone Number : 541-267-5151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 11/04/2020

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Directions to “ ANGELA RENEE YORK N.P.” Practice Location

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