Provider Demographics
NPI:1548358187
Name:FOX, VICKI L (ARNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 AMBAUM BLVD SW
Mailing Address - Street 2:106
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1449
Mailing Address - Country:US
Mailing Address - Phone:206-244-5520
Mailing Address - Fax:206-957-0034
Practice Address - Street 1:14212 AMBAUM BLVD SW
Practice Address - Street 2:106
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1449
Practice Address - Country:US
Practice Address - Phone:206-244-5520
Practice Address - Fax:206-957-0034
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001950363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA005OtherTRICARE
WA56184OtherWORKERS COMPENSATION
WA9636137Medicaid