Healthcare Provider Details

I. General information

NPI: 1427881457
Provider Name (Legal Business Name): NIKA KOBOZEV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST SEATTLE
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-4869
US

V. Phone/Fax

Practice location:
  • Phone: 425-647-0319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60965497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: