Provider Demographics
NPI:1164166443
Name:WASHINGTON, VICKI LYNN (DNP, RN, APRN, ACNS-)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DNP, RN, APRN, ACNS-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6818
Mailing Address - Country:US
Mailing Address - Phone:734-657-5947
Mailing Address - Fax:
Practice Address - Street 1:5152 PECAN DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6818
Practice Address - Country:US
Practice Address - Phone:734-657-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157488364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty