MEDICARE: MARISSA VATERNICK RN

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	163W00000X	Registered Nurse	61075050	WA

General Provider Information

NPI Number	:	1659144012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA VATERNICK RN

Provider Business Mailing Address
First Line	:	1427 11TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4893
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11530 12TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6310
Country	:	US
Telephone Number	:	206-252-4610
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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