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General NPI Number Information
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NPI Number | 1518132224
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Entity Type | Individual
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Provider Name | MICHAEL DAMON WASCHER NP
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Gender | Male
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 101 BODIN CIRCLE
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1800
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Country | US
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Telephone | 707-423-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 W TEXAS ST APT. # 103
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City | FAIRFIELD
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State | CA
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Zip | 94533-4468
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Country | US
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Telephone | 301-651-4650
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 471117
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 53183
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18538
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License Number State | CA
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