Provider Demographics
NPI:1154157386
Name:POLITO, ANGELINA M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:M
Last Name:POLITO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NE 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3934
Mailing Address - Country:US
Mailing Address - Phone:503-460-0405
Mailing Address - Fax:503-460-0434
Practice Address - Street 1:1410 NE 106TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3934
Practice Address - Country:US
Practice Address - Phone:503-460-0405
Practice Address - Fax:503-460-0434
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10048439363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health