Provider Demographics
NPI:1346848561
Name:KANGAS, HEIDI LYNNETTE (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNETTE
Last Name:KANGAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SOLOMON RD APT A3
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-1751
Mailing Address - Country:US
Mailing Address - Phone:360-957-9294
Mailing Address - Fax:
Practice Address - Street 1:1128 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3831
Practice Address - Country:US
Practice Address - Phone:360-999-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60823371163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health