Provider Demographics
NPI:1548089220
Name:WETMORE, MARYELLEN VOGT (RN)
Entity type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:VOGT
Last Name:WETMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 CATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5109
Mailing Address - Country:US
Mailing Address - Phone:703-784-1772
Mailing Address - Fax:703-784-1895
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:703-784-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431243163WA2000X, 163WM0705X, 163WC0400X
VA0001253807163WA2000X, 163WM0705X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical