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General NPI Number Information
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NPI Number | 1457027112
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Entity Type | Individual
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Provider Name | PATRICIA ANNE VAN VACTOR ARNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 12423 TOTEM LAKE BLVD NE
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City | KIRKLAND
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State | WA
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Zip | 98034-7504
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Country | US
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Telephone | 425-406-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 17550 156TH PL NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-9214
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Country | US
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Telephone | 206-818-9770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP.AP.61148478-NP
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License Number State | WA
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