Provider Demographics
NPI:1114977642
Name:DENSON, VICKI LYNN (PHD, MSN, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:DENSON
Suffix:
Gender:F
Credentials:PHD, MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 NE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0919
Mailing Address - Country:US
Mailing Address - Phone:360-694-0355
Mailing Address - Fax:
Practice Address - Street 1:8000 NE 58TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0919
Practice Address - Country:US
Practice Address - Phone:360-694-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN105739363LW0102X
AZAP1548363LW0102X
OR201250195NP363LW0102X
WAAP60518718363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703828Medicaid
P84230Medicare UPIN
AZ703828Medicaid