Provider Demographics
NPI:1124797279
Name:VANDIVER, NATALIYA (RN)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 158TH AVENUE CT E APT SUITE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3148
Mailing Address - Country:US
Mailing Address - Phone:253-359-2350
Mailing Address - Fax:
Practice Address - Street 1:5705 158TH AVENUE CT E APT SUITE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3148
Practice Address - Country:US
Practice Address - Phone:253-359-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60352730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse