1023583622 NPI number — VERA WHOLE HEALTH WA PC

Table of content: (NPI 1023583622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023583622 NPI number — VERA WHOLE HEALTH WA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERA WHOLE HEALTH WA PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VERA WHOLE HEALTH RENO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023583622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 2ND AVE STE 1400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-395-7870
Provider Business Mailing Address Fax Number:
206-770-6159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
699 SIERRA ROSE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-299-4649
Provider Business Practice Location Address Fax Number:
775-313-9707
Provider Enumeration Date:
10/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
JANELL
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING ANALYST
Authorized Official Telephone Number:
206-395-6973

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NV20181406430 . This is a "STATE BUSINESS LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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