Provider Demographics
NPI:1225620099
Name:PESIK, ANGELA LEIGH (MSN, FNP,ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEIGH
Last Name:PESIK
Suffix:
Gender:F
Credentials:MSN, FNP,ARNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MOHNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4411
Mailing Address - Country:US
Mailing Address - Phone:509-301-1540
Mailing Address - Fax:
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2837
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61137102363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily