Provider Demographics
NPI:1740863000
Name:VAZQUEZ-NATER, VICKI (RN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:VAZQUEZ-NATER
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 1:154 MCMAKIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4816
Mailing Address - Country:US
Mailing Address - Phone:704-491-6028
Mailing Address - Fax:
Practice Address - Street 1:154 MCMAKIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-4816
Practice Address - Country:US
Practice Address - Phone:704-491-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83010163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice