Provider Demographics
NPI:1659763951
Name:JULAGAY, ANGELLA
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:
Last Name:JULAGAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SIXTH AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5396
Mailing Address - Country:US
Mailing Address - Phone:208-265-6252
Mailing Address - Fax:208-265-8214
Practice Address - Street 1:810 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5396
Practice Address - Country:US
Practice Address - Phone:208-265-6252
Practice Address - Fax:208-265-8214
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60533427363L00000X, 363LF0000X, 363LP0808X, 363LP0808X
ID59009363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily