Provider Demographics
NPI:1447334230
Name:LOFTEN, VIENNA DEE ANN (NP-C)
Entity type:Individual
Prefix:
First Name:VIENNA
Middle Name:DEE ANN
Last Name:LOFTEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 W TUCANNON AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7178
Mailing Address - Country:US
Mailing Address - Phone:509-627-2848
Mailing Address - Fax:509-627-2849
Practice Address - Street 1:8904 W TUCANNON AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7178
Practice Address - Country:US
Practice Address - Phone:509-627-2848
Practice Address - Fax:509-627-2849
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60249851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022829Medicaid