Healthcare Provider Details

I. General information

NPI: 1780702399
Provider Name (Legal Business Name): NANCY CARR PASCUA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NE FOURTH PLAIN BLVD. BLDG 17, S SUITE B222
VANCOUVER WA
98661
US

IV. Provider business mailing address

PO BOX 1845
VANCOUVER WA
98668-1845
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8484
  • Fax: 360-993-3047
Mailing address:
  • Phone: 360-397-8484
  • Fax: 360-993-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60268409
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00166024
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: