Basic Information
Provider Information
NPI: 1528391794
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELCASTER
FirstName: ANGELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3600 MERIDIAN ST
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 982251732
CountryCode: US
TelephoneNumber: 3606766000
FaxNumber: 3606766006
Practice Location
Address1: 3600 MERIDIAN ST
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 982251732
CountryCode: US
TelephoneNumber: 3606766000
FaxNumber: 3606766006
Other Information
ProviderEnumerationDate: 09/06/2009
LastUpdateDate: 09/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP60112444WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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