Healthcare Provider Details

I. General information

NPI: 1356954325
Provider Name (Legal Business Name): VANESSA CERVANTES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA VALENZUELA

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

IV. Provider business mailing address

1305 TACOMA AVE S STE 201
TACOMA WA
98402-1903
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5935
  • Fax: 253-566-2252
Mailing address:
  • Phone: 253-396-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number61033880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: