Healthcare Provider Details

I. General information

NPI: 1538141346
Provider Name (Legal Business Name): MARION L VIGUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST MAPLE STREET
MEDICAL LAKE WA
99022-0800
US

IV. Provider business mailing address

800 WEST MAPLE STREET P O BOX 800
MEDICAL LAKE WA
99022-0800
US

V. Phone/Fax

Practice location:
  • Phone: 509-299-3121
  • Fax: 509-299-7015
Mailing address:
  • Phone: 509-299-3121
  • Fax: 509-299-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30002543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: