Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301103168 | MI |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | D84223 | MD |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD60982673 | WA |
NPI | 1023457371 |
---|---|
Provider Name | Nishant Nannapaneni |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 07/11/2019 |