Provider Demographics
NPI:1316979172
Name:FIELDS-VOCELKA, VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FIELDS-VOCELKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:F
Other - Last Name:VOCELKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9411
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9411
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:360-307-7304
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8324170Medicaid
WA8324170Medicaid
WA8802796Medicare ID - Type Unspecified
WA8861229Medicare PIN