MEDICARE: VICKI R WERVE ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP30005377	WA
2	363LF0000X	Family Nurse Practitioner	RN00076147	WA

General Provider Information

NPI Number	:	1154385433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI R WERVE ARNP

Provider Business Mailing Address
First Line	:	11245 SR 525
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236
Country	:	US
Telephone Number	:	360-341-5252
Fax Number	:	360-341-8727

Provider Business Practice Location Address
First Line	:	11245 SR 525
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236
Country	:	US
Telephone Number	:	360-341-5252
Fax Number	:	360-341-8727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	02/18/2010

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Directions to “ VICKI R WERVE ARNP” Practice Location

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