Provider Demographics
NPI:1386963973
Name:MARTIN-VEGUE, KELLY ANDERS (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANDERS
Last Name:MARTIN-VEGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANDERS
Other - Last Name:SEHRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4338 28TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-6102
Mailing Address - Country:US
Mailing Address - Phone:206-354-6327
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE # 359947
Practice Address - Street 2:HARBORVIEW CENTER FOR SEXUAL ASSAULT & TRAUMATIC STRESS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00156146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse