Healthcare Provider Details

I. General information

NPI: 1073532305
Provider Name (Legal Business Name): KEITH W. VAN METER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST # 356158
SEATTLE WA
98195-6158
US

IV. Provider business mailing address

1959 NE PACIFIC ST # 356158
SEATTLE WA
98195-6158
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-8412
  • Fax: 206-598-6986
Mailing address:
  • Phone: 206-598-8412
  • Fax: 206-598-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003468
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00068957
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: