MEDICARE: SANDRA VANVIG ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP30004771	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114073301	OTHER	WA	NPI

General Provider Information

NPI Number	:	1114073301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA VANVIG ARNP

Provider Business Mailing Address
First Line	:	PO BOX 1212
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-0912
Country	:	US
Telephone Number	:	360-440-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 QUINCY ST
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-5525
Country	:	US
Telephone Number	:	360-440-6220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	09/06/2013

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