Healthcare Provider Details

I. General information

NPI: 1215961404
Provider Name (Legal Business Name): VANESSA F RATCLIFF CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA FAYE EKVALL WILLEY

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/26/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WHEELER RD
MOSES LAKE WA
98837-1820
US

IV. Provider business mailing address

660 S COOLIDGE ST
MOSES LAKE WA
98837-1872
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-5606
  • Fax:
Mailing address:
  • Phone: 509-793-9715
  • Fax: 509-764-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007386
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number45126
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30007386
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: