Provider Demographics
NPI:1841389517
Name:COLLINS, ANGELA JEANETTE (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JEANETTE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:JEANETTE
Other - Last Name:CASTEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:291 C ST UNIT 110
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2168
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1644
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4347207Q00000X
WAOP61072319207Q00000X
MO2007008847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
250766OtherHEALTHLINK
MO1841389517Medicaid
431560263OtherTRICARE WEST
AR178257003Medicaid
OK200090850AMedicaid
MOP00730801OtherRAILROAD MEDICARE
124900001Medicare PIN
MOP00730801OtherRAILROAD MEDICARE
431560263OtherTRICARE WEST