Healthcare Provider Details

I. General information

NPI: 1952623027
Provider Name (Legal Business Name): NISQUALLY INDIAN TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 JOURNEY ST SE
OLYMPIA WA
98513-6779
US

IV. Provider business mailing address

4840 JOURNEY ST SE
OLYMPIA WA
98513-6779
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9770
  • Fax: 360-486-9556
Mailing address:
  • Phone: 360-459-5312
  • Fax: 360-486-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HUSTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 360-459-5312