Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60323516 | WA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP 60323516 | WA |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP 60323516 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP 60323516 | WA |
NPI | 1093056046 |
---|---|
Provider Name | Radu Ivan |
First Address | Bellingham, WA 98226-7123 |
Second Address | Bellingham, WA 98226-7123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2013 |
Last Update Date | 14/03/2013 |