Provider Demographics
NPI:1497931869
Name:VIEIRA, NANCY JO
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JO
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:JO
Other - Last Name:VIEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MACOM, RN
Mailing Address - Street 1:1713 NE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0571
Mailing Address - Country:US
Mailing Address - Phone:360-798-5346
Mailing Address - Fax:
Practice Address - Street 1:1906 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3325
Practice Address - Country:US
Practice Address - Phone:360-694-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA028241OtherDIPL. AC
WAAC00003046OtherLAC WA STATE
WARN00124870OtherRN