Healthcare Provider Details

I. General information

NPI: 1639083736
Provider Name (Legal Business Name): ANN VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 SUMMITVIEW AVE
YAKIMA WA
98908-2858
US

IV. Provider business mailing address

421 S 3RD ST
SELAH WA
98942-1609
US

V. Phone/Fax

Practice location:
  • Phone: 509-907-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDIET.DI.70147082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: