Provider Demographics
NPI:1295445559
Name:VIGILEOS, REBEKAH (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:VIGILEOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 W SHOREWOOD DR APT 539
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-6218
Mailing Address - Country:US
Mailing Address - Phone:480-434-9153
Mailing Address - Fax:
Practice Address - Street 1:9007 W SHOREWOOD DR APT 539
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-6218
Practice Address - Country:US
Practice Address - Phone:480-434-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61377070363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health