Provider Demographics
NPI:1619657160
Name:AWAKEN, PLLC
Entity Type:Organization
Organization Name:AWAKEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:COOL
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:540-588-9996
Mailing Address - Street 1:4533 BRAMBLETON AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3436
Mailing Address - Country:US
Mailing Address - Phone:540-525-7020
Mailing Address - Fax:
Practice Address - Street 1:4533 BRAMBLETON AVE STE 13
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3436
Practice Address - Country:US
Practice Address - Phone:540-588-9996
Practice Address - Fax:540-779-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center