Provider Demographics
NPI:1881102077
Name:VERA WHOLE HEALTH WA PC
Entity type:Organization
Organization Name:VERA WHOLE HEALTH WA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSING ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCHFELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-395-7870
Mailing Address - Street 1:1201 2ND AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3020
Mailing Address - Country:US
Mailing Address - Phone:206-395-7870
Mailing Address - Fax:
Practice Address - Street 1:393 W ANTELOPE RD
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1027
Practice Address - Country:US
Practice Address - Phone:541-600-4610
Practice Address - Fax:541-550-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01714514-4261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care