Healthcare Provider Details

I. General information

NPI: 1295142750
Provider Name (Legal Business Name): NASHWA ABDULSALAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL STE 400
VANCOUVER WA
98664-3290
US

IV. Provider business mailing address

310 EXCHANGE BLVD APT 324
ROCHESTER NY
14608-2780
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-4444
  • Fax: 360-514-6530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61038401
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD61038401
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD61038401
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: