Provider Demographics
NPI:1467889451
Name:WETMORE, ANGELA MERRISA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MERRISA
Last Name:WETMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W COLLEGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5060
Mailing Address - Country:US
Mailing Address - Phone:707-526-3500
Mailing Address - Fax:
Practice Address - Street 1:585 W COLLEGE AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5060
Practice Address - Country:US
Practice Address - Phone:707-526-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23268363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical