Healthcare Provider Details

I. General information

NPI: 1295445559
Provider Name (Legal Business Name): REBEKAH VIGILEOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9007 W SHOREWOOD DR APT 539
MERCER ISLAND WA
98040-6218
US

IV. Provider business mailing address

9007 W SHOREWOOD DR APT 539
MERCER ISLAND WA
98040-6218
US

V. Phone/Fax

Practice location:
  • Phone: 480-434-9153
  • Fax:
Mailing address:
  • Phone: 480-434-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61377070
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: