Provider Demographics
NPI:1407976921
Name:WEBBER, ANGELA LYONS (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYONS
Last Name:WEBBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11600 SW LAUSANNE ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7331
Mailing Address - Country:US
Mailing Address - Phone:503-364-2181
Mailing Address - Fax:503-364-0364
Practice Address - Street 1:891 23RD ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1793
Practice Address - Country:US
Practice Address - Phone:503-364-2181
Practice Address - Fax:503-364-0364
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA 01001363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical