Healthcare Provider Details

I. General information

NPI: 1336991447
Provider Name (Legal Business Name): DANAE VERMULM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 91ST AVE NE
LAKE STEVENS WA
98258-2420
US

IV. Provider business mailing address

2859 OLD HIGHWAY 99 NORTH RD
BURLINGTON WA
98233-8561
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone: 360-708-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: