Provider Demographics
NPI:1710951157
Name:HEINZ, VICTORIA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:HEINZ
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 1:3505 NW ANDERSON HILL RD
Mailing Address - Street 2:#201
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9161
Mailing Address - Country:US
Mailing Address - Phone:360-698-6859
Mailing Address - Fax:360-337-7403
Practice Address - Street 1:3505 NW ANDERSON HILL RD
Practice Address - Street 2:#201
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9161
Practice Address - Country:US
Practice Address - Phone:360-698-6859
Practice Address - Fax:360-337-7403
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128218Medicaid
WA7128218Medicaid
WAP71031Medicare UPIN