Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A121297 | CA |
N | 207RN0300X | Nephrologist | MD60668555 | WA |
NPI | 1053636977 |
---|---|
Provider Name | Theresa Nilson Henke |
First Address | Seattle, WA 98104-1132 |
Second Address | Los Angeles, CA 90048-6146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2010 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8955946 | (02) | WA |