Provider Demographics
NPI:1851034193
Name:WANDERER, ANGELA CATHERINE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CATHERINE
Last Name:WANDERER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1818 S LANE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2908
Mailing Address - Country:US
Mailing Address - Phone:206-349-7651
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-583-2299
Practice Address - Fax:206-223-6395
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61265930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily