Healthcare Provider Details

I. General information

NPI: 1306874748
Provider Name (Legal Business Name): KAREN M VIGELAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVENUE BLDG B SUITE 303
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

505 NE 87TH AVENUE BLDG B SUITE 303
VANCOUVER WA
98664-1965
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5267
  • Fax: 360-254-6089
Mailing address:
  • Phone: 360-254-5267
  • Fax: 360-254-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00017848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: