Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | Q8523 | TX |
NPI | 1013270875 |
---|---|
Provider Name | Nicholas Andrew Juan |
First Address | Kennewick, WA 99336-3400 |
Second Address | Kennewick, WA 99336-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2079915 | (05) | WA |