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General NPI Number Information
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NPI Number | 1063904696
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Entity Type | Individual
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Provider Name | NIKITASHA AGGARWAL DO
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 1800 COOKS HILL RD STE F
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City | CENTRALIA
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State | WA
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Zip | 98531-9162
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Country | US
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Telephone | 360-669-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 2690 NE KRESKY AVE
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City | CHEHALIS
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State | WA
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Zip | 98532-2412
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Country | US
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Telephone | 306-330-9595
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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 | MED-PHYS-LIC-103020
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO.OP.61520884
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License Number State | WA
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