Provider Demographics
NPI:1912289364
Name:NELSON, VICKI GAE (RDH)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:GAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24105 184TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4896
Mailing Address - Country:US
Mailing Address - Phone:425-433-6221
Mailing Address - Fax:
Practice Address - Street 1:221 WINSLOW WAY W STE 302
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4917
Practice Address - Country:US
Practice Address - Phone:206-909-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001057124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist