Provider Demographics
NPI:1609471242
Name:GUM, ANGELA (MSN, BS, RN-BC,)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GUM
Suffix:
Gender:F
Credentials:MSN, BS, RN-BC,
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:VASLOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-6200
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60415133163WP0808X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine