Healthcare Provider Details

I. General information

NPI: 1518883255
Provider Name (Legal Business Name): NISHALL IRENE BISI GUTIERREZ HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 SE 38TH ST STE 104
BELLEVUE WA
98006-5232
US

IV. Provider business mailing address

12600 SE 38TH ST STE 104
BELLEVUE WA
98006-5232
US

V. Phone/Fax

Practice location:
  • Phone: 425-457-7999
  • Fax: 425-679-5968
Mailing address:
  • Phone: 425-457-7999
  • Fax: 425-679-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHIFD.HA.70033669
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: