Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP61095225 | CA |
NPI | 1023504693 |
---|---|
Provider Name | Vincent J Meno |
First Address | Longview, WA 98632-3166 |
Second Address | Woodland, WA 98674-9226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2018 |
Last Update Date | 29/12/2021 |