Healthcare Provider Details

I. General information

NPI: 1861968612
Provider Name (Legal Business Name): NASIR GEBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PACIFIC AVE STE C6
TACOMA WA
98402-4393
US

IV. Provider business mailing address

1201 PACIFIC AVE STE C6
TACOMA WA
98402-4393
US

V. Phone/Fax

Practice location:
  • Phone: 208-512-2647
  • Fax:
Mailing address:
  • Phone: 822-722-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61237721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: