Provider Demographics
NPI:1831260637
Name:LEDGERWOOD-VAN VLECK, NANCY (ARNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:LEDGERWOOD-VAN VLECK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26853 165TH PL SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 W. JAMES STREET
Practice Address - Street 2:RJC KENT JAIL HEALTH CLINIC,
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4487
Practice Address - Country:US
Practice Address - Phone:206-205-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30000229OtherSTATE NURSE PRACTITIONER
WAAP30000229OtherSTATE NURSE PRACTITIONER
WAMV0107260OtherDEA
WAAP30000229OtherSTATE NURSE PRACTITIONER
WAAB07075Medicare ID - Type Unspecified