Basic Information
| Provider Information | |||||||||
| NPI: | 1245441518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLETCHER | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | CHERYL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063287722 | ||||||||
| FaxNumber: | 2067204657 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 E MADISON ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063287722 | ||||||||
| FaxNumber: | 2067204657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP30004060 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | MF0955813 | 01 | WA | DEA | OTHER | 9600347 | 05 | WA | MEDICAID |