Doctor Name: | ANGELA MARIE PETLOW |
NPI Number: | 1851734396 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP60325998 |
Business Practice Address: | 7520 Totem Beach Rd Tulalip, WA - 982716160 |
Business Phone Number: | 3607164511 |
Business Fax Number: | 3607165782 |
Mailing Address: | 7520 Totem Beach Rd, TULALIP |
State: | WA |
Postal Code: | 982716160 |
Phone Number: | 3607164511 |
Fax Number: | 3607165782 |
NPI Enumeration Date: | 04/15/2013 |
NPI Last Update Date: | 02/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60325998 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |