Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60497652 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60497652 | WA |
NPI | 1164812798 |
---|---|
Provider Name | Paul Niemi |
First Address | Enumclaw, WA 98022-3634 |
Second Address | Enumclaw, WA 98022-3634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2043223 | (05) | WA |