Healthcare Provider Details

I. General information

NPI: 1649418773
Provider Name (Legal Business Name): REBECCA MAE NERISON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A FITZSIMMONS DR INTERNAL MEDICINE CLINIC - MAMC
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040A FITZSIMMONS DR INTERNAL MEDICINE CLINIC - MAMC
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5154
  • Fax: 253-968-5154
Mailing address:
  • Phone: 253-968-5154
  • Fax: 253-968-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2213
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: