Healthcare Provider Details

I. General information

NPI: 1376704726
Provider Name (Legal Business Name): VICKIE MARIE O'NEAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR
TACOMA WA
98493-0001
US

IV. Provider business mailing address

9600 VETERANS DR
TACOMA WA
98493-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1681
  • Fax: 253-589-4183
Mailing address:
  • Phone: 253-583-1681
  • Fax: 253-589-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30006351
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: