Healthcare Provider Details

I. General information

NPI: 1154385433
Provider Name (Legal Business Name): VICKI R WERVE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICKI R AHO

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 SR 525
CLINTON WA
98236
US

IV. Provider business mailing address

11245 SR 525
CLINTON WA
98236
US

V. Phone/Fax

Practice location:
  • Phone: 360-341-5252
  • Fax: 360-341-8727
Mailing address:
  • Phone: 360-341-5252
  • Fax: 360-341-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005377
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN00076147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: