Angela M Black, C.N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP60909585 Issued in WA

Practice address

901 Rainier Ave S
Seattle, WA 98144-2839

Phone

(206) 470-3880

NPI assigned

Aug 9, 2012

Last updated

Jan 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marquis Clinical Services LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Milwaukie, OR
  • NPI 1710427810
  Medicare reassignment NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1447507462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6009 SW TAYLORS FERRY RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972195627",
            "telephone_number": "740-398-6674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 RAINIER AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442839",
            "telephone_number": "206-470-3880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Woodland Dr",
            "address_purpose": "LOCATION",
            "city": "Coos Bay",
            "state": "OR",
            "postal_code": "974202045",
            "country_code": "US",
            "telephone_number": "541-267-5151 x1314",
            "fax_number": "541-266-4565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2671 NE 46th St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98105",
            "country_code": "US",
            "telephone_number": "206-525-8000",
            "fax_number": "206-525-8070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "ANGELA",
        "middle_name": "M",
        "credential": "C.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-09",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA.13918-NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "201506660NP-PP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60909585",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "335437",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500691918",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ivy Bjornson, LMP
• Kristie Fay Bjornson, PHD, PT, MS
• Petter Mathias Bjornstad, MD
• Jeanne Marie Blache, ARNP
• Amanda Jane Black
• Anneliese Echo Black, RN
• Brian Black, PTA
• Charlotte Black, CCC-SLP
• Christina Black, PA-C
• Cindy Meredith Black, BA

• Nurse Practitioner in Seattle, WA
• Providers in Seattle, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.