Provider Demographics
NPI:1235566290
Name:WEILAND, VANESSA L (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:WEILAND
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:L
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ARNP
Mailing Address - Street 1:8255 ASHWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4434
Mailing Address - Country:US
Mailing Address - Phone:206-485-8765
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:206-485-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60424951163W00000X
WA60424953363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386626281Medicaid
WA1386626281Medicaid