Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP30001835 | WA |
NPI | 1013098656 |
---|---|
Provider Name | Joyce Ninnemann |
First Address | Zillah, WA 98953-9298 |
Second Address | Zillah, WA 98953-9298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 25/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP30001835 | LICENSE NUMBER (01) | WA |