Individual
JESSICA M S VITTENGL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2979 SQUALICUM PKWY, SUITE 101, BELLINGHAM, WA 98225-1811
(360) 734-2700
(360) 734-8362
Mailing address
PO BOX 5096, BELLINGHAM, WA 98227-5096
(360) 734-2700
(360) 734-8362
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30007851
WA
363LA2100X
Acute Care Nurse Practitioner
AP30007851
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0164VI
REGENCE BLUE SHIELD
WA
01
—
0280023
L&I AND CRIME VICTIMS
WA
05
—
1073707980
—
WA
05
—
9654005
—
WA
01
—
AF03
TRI WEST (TRICARE)
WA
Enumeration date
09/04/2007
Last updated
07/21/2011
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