Individual
MR. NATHAN VANVICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
888 SWIFT BLVD, RICHLAND, WA 99352-3514
(541) 910-3878
Mailing address
6612 OPAL CT, WEST RICHLAND, WA 99353-7961
(541) 910-3878
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201391621RN
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60634596
WA
Other
Enumeration date
08/27/2013
Last updated
02/08/2016
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