Provider Demographics
NPI:1114905114
Name:VERGA, CAROL ANN (CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:VERGA
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 BLACKFORD LANE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-230-8925
Mailing Address - Fax:
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 500
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-4455
Practice Address - Fax:425-899-4434
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0000063363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615352Medicaid
WAS94864Medicare UPIN
WAAB15428Medicare ID - Type Unspecified