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General NPI Number Information
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NPI Number | 1013244367
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Entity Type | Individual
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Provider Name | MARY CATHLEEN NISHIMURA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 888 N QUINCY ST UNIT 2105
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City | ARLINGTON
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State | VA
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Zip | 22203-2078
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Country | US
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Telephone | 717-609-5897
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Fax |
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Provider Business Mailing Address
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Address Line | 888 N QUINCY ST UNIT 2105
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City | ARLINGTON
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State | VA
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Zip | 22203-2078
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Country | US
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Telephone | 717-609-5897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-6045
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License Number State | HI
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