Provider Demographics
NPI:1376054163
Name:BARTLETT, ANGELA YVONNE (RN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:YVONNE
Last Name:BARTLETT
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 1:19835 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2246
Mailing Address - Country:US
Mailing Address - Phone:206-631-3011
Mailing Address - Fax:206-631-3385
Practice Address - Street 1:19835 8TH AVE S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98148-2246
Practice Address - Country:US
Practice Address - Phone:206-255-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP053560164W00000X
WARN61079973163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty