Provider Demographics
NPI:1962230524
Name:NIDA, ANGELA RENEE (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:NIDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9207 NE 128TH LN
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5915
Mailing Address - Country:US
Mailing Address - Phone:308-520-6747
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6945
Practice Address - Country:US
Practice Address - Phone:308-520-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60875345163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health