Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD00038395 | WA |
NPI | 1003969270 |
---|---|
Provider Name | Michael L. Nevins |
First Address | Seattle, WA 98112-5226 |
Second Address | Seattle, WA 98112-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8254468 | (05) | WA |
G70183 | (02) | WA |