Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | M-8949 | ID |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD00037581 | WA |
NPI | 1093713943 |
---|---|
Provider Name | Dr. Steven J. Nisco |
First Address | Spokane, WA 99204-2321 |
Second Address | Spokane, WA 99204-2321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11129351 | MEDICARE PTAN (01) | ID |
805475600 | (05) | ID |
8246639 | (05) | WA |
F43366 | (02) | |
G8870915 | MEDICARE PTAN (01) | WA |
G8877881 | MEDICARE PTAN (01) | WA |