Healthcare Provider Details

I. General information

NPI: 1356114185
Provider Name (Legal Business Name): VERONICA CERVANTES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

4455 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-7147
  • Fax:
Mailing address:
  • Phone: 360-788-7147
  • Fax: 360-715-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61483784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: