Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60474112 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60474112 | WA |
NPI | 1033522065 |
---|---|
Provider Name | Nissa Freed |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033522065 | (05) | WA |