Provider Demographics
NPI:1134944648
Name:BENNETT, ANGELA MICHELE (NP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4801
Mailing Address - Country:US
Mailing Address - Phone:678-697-1282
Mailing Address - Fax:
Practice Address - Street 1:8837 36TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4801
Practice Address - Country:US
Practice Address - Phone:678-697-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61624878363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner