Healthcare Provider Details

I. General information

NPI: 1811223894
Provider Name (Legal Business Name): HEIKE INGRID NUHSBAUM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N BROADWAY SUITE A-3
EVERETT WA
98201-1585
US

IV. Provider business mailing address

909 N BROADWAY PBO
EVERETT WA
98201-1401
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-0300
  • Fax: 425-317-0303
Mailing address:
  • Phone: 425-317-0300
  • Fax: 425-317-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60047365
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60047365
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00161181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: