Provider Demographics
NPI:1013016591
Name:ANG, BETTY (PHD, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:ANG
Suffix:
Gender:F
Credentials:PHD, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OAK STREET SE
Mailing Address - Street 2:SALEM VA OUTPATIENT CLINIC
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-316-8817
Mailing Address - Fax:503-316-9037
Practice Address - Street 1:1660 OAK ST SE
Practice Address - Street 2:SALEM VA OUTPATIENT CLINIC
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-6942
Practice Address - Country:US
Practice Address - Phone:503-316-8817
Practice Address - Fax:503-316-9037
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health