1578654463 NPI number — VICKI MARIE STEVENS ARNP

Table of content: VICKI MARIE STEVENS ARNP (NPI 1578654463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578654463 NPI number — VICKI MARIE STEVENS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
VICKI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOERNER
Provider Other First Name:
VICKI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578654463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 N MCDONALD RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99216-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-924-1950
Provider Business Mailing Address Fax Number:
509-921-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 N MCDONALD RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-1950
Provider Business Practice Location Address Fax Number:
509-921-0017
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP30005599 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010137756 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 9638883 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806695700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0161234 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 500020906 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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