Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 1050911A | IN |
Y | 2086S0129X | Vascular Surgeon | MD00048859 | WA |
NPI | 1104874569 |
---|---|
Provider Name | Dr. Ryan D. Nachreiner |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200250360A | (05) | IN |
H88098 | (02) |