Provider Demographics
NPI:1023504693
Name:MENO, VINCENT J
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:MENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3166
Mailing Address - Country:US
Mailing Address - Phone:360-575-4899
Mailing Address - Fax:
Practice Address - Street 1:170 DEE CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9226
Practice Address - Country:US
Practice Address - Phone:562-716-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95129001163WE0003X
CAAP61095225363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency