Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00035357 | WA |
N | 207VX0000X | Obstetrician | MD00035357 | WA |
NPI | 1093729873 |
---|---|
Provider Name | Michele K Nelsen |
First Address | Renton, WA 98057-4970 |
Second Address | Renton, WA 98058-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 31/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1042822 | (05) | WA |
G8891361 | MEDICARE W VALLEY MEDICAL GROUP - RENTON (01) | WA |