Provider Demographics
NPI:1578507547
Name:BEAN, ANGELA FAYE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAYE
Last Name:BEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:F
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2400 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-757-2400
Mailing Address - Fax:541-752-0931
Practice Address - Street 1:2400 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-757-2400
Practice Address - Fax:541-752-0931
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8475667Medicaid
Q59288Medicare UPIN
WA8865260Medicare PIN