Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30001950 | WA |
NPI | 1548358187 |
---|---|
Provider Name | Vicki L Fox |
First Address | Burien, WA 98166-1449 |
Second Address | Burien, WA 98166-1449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 20/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56184 | WORKERS COMPENSATION (01) | WA |
9636137 | (05) | WA |
A005 | TRICARE (01) | WA |