Provider Demographics
NPI:1295724375
Name:FAUCHER, VICKI TARVER (FNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:TARVER
Last Name:FAUCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-380-2670
Mailing Address - Fax:949-380-0907
Practice Address - Street 1:24411 HEALTH CENTER DR STE 320
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-380-2670
Practice Address - Fax:949-380-0907
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650051NP363L00000X, 363L00000X
CA13768363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240031Medicaid
ORP01779259OtherRAILROAD MEDICARE
ORR134734Medicare PIN
OR240031Medicaid
ORP01779259OtherRAILROAD MEDICARE
OR0577260001Medicare NSC
ORR0000WFBTVOtherGROUP PIN NUMBER
ORQ69724Medicare UPIN