Healthcare Provider Details

I. General information

NPI: 1740671601
Provider Name (Legal Business Name): ADRIAN MARC RAMOS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL STE 330
VANCOUVER WA
98664-3288
US

IV. Provider business mailing address

7173 GASTON AVE APT 1309
DALLAS TX
75214-6132
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2990
  • Fax: 360-514-3508
Mailing address:
  • Phone: 214-864-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61321127
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61321127
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: