Provider Demographics
NPI:1508016817
Name:BESAW, ANGELA M (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BESAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEM
Mailing Address - Street 2:1905 E HUEBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:BELOIT HEALTH SYSTEM UW CANCER CENTER
Practice Address - Street 2:1670 LEE LANE
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3935
Practice Address - Country:US
Practice Address - Phone:608-364-5253
Practice Address - Fax:608-364-5252
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111407-030363L00000X
WI3625-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36094700Medicaid
WI048354340Medicare PIN
WIP00698006Medicare PIN
WIK400110634Medicare PIN