Provider Demographics
NPI:1578654463
Name:STEVENS, VICKI MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:MARIE
Other - Last Name:HOERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1557
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-921-0017
Practice Address - Street 1:1215 N MCDONALD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1557
Practice Address - Country:US
Practice Address - Phone:509-924-1950
Practice Address - Fax:509-921-0017
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005599363L00000X, 363LA2200X
IDNP554A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010137756OtherREGENCE BLUE SHIELD
WA9638883Medicaid
ID806695700Medicaid
WA0161234OtherL&I
500020906OtherRAILROAD MEDICARE
WAAB21085Medicare ID - Type Unspecified
ID000010137756OtherREGENCE BLUE SHIELD