Provider Demographics
NPI:1154385433
Name:WERVE, VICKI R (ARNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:WERVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:R
Other - Last Name:AHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11245 SR 525
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236
Mailing Address - Country:US
Mailing Address - Phone:360-341-5252
Mailing Address - Fax:360-341-8727
Practice Address - Street 1:11245 SR 525
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236
Practice Address - Country:US
Practice Address - Phone:360-341-5252
Practice Address - Fax:360-341-8727
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005377363LF0000X
WARN00076147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31767Medicare UPIN