Provider Demographics
NPI:1922081850
Name:WEGENAST, VIRGINIA JOY (RN RNC CNOR CRNFA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JOY
Last Name:WEGENAST
Suffix:
Gender:F
Credentials:RN RNC CNOR CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 52ND AVE W
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2366
Mailing Address - Country:US
Mailing Address - Phone:425-238-3495
Mailing Address - Fax:425-355-9855
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-317-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0065887163W00000X
WARN00065887163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9611104Medicaid
R00078OtherREGENENCE