Provider Demographics
NPI:1558413799
Name:WILGRESS, RENEE PATRICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:PATRICIA
Last Name:WILGRESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGH ST # MS 9132
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5946
Mailing Address - Country:US
Mailing Address - Phone:360-650-2633
Mailing Address - Fax:
Practice Address - Street 1:516 HIGH ST # MS 9132
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5946
Practice Address - Country:US
Practice Address - Phone:360-650-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0267792OtherL&I/CRIME VICTIMS
WA1558413799OtherMEDICAID DSHS PROVIDER ONE
G8894358OtherMEDICARE PTAN
Q28804Medicare UPIN