Provider Demographics
NPI:1760574719
Name:WEGERMANN, VALERIE L (ARNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:WEGERMANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:909 N BROADWAY
Mailing Address - Street 2:PBO
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-317-0699
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:SUITE A-3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1586
Practice Address - Country:US
Practice Address - Phone:425-317-0300
Practice Address - Fax:425-317-0303
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000732363L00000X
WARN00070583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622739Medicaid
WAS64670Medicare UPIN
WA9622739Medicaid
WAAB40139Medicare PIN