Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 303485 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD2021-0661 | NM |
NPI | 1144663782 |
---|---|
Provider Name | Jennifer Mika Nishimura |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 12/08/2021 |