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General NPI Number Information
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NPI Number | 1710875257
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Entity Type | Individual
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Provider Name | NISMA IBRAHIM MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2101 SW SUNSET BLVD APT E401
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City | RENTON
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State | WA
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Zip | 98057-6140
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Country | US
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Telephone | 714-483-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 SW SUNSET BLVD APT E401
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City | RENTON
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State | WA
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Zip | 98057-6140
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Country | US
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Telephone | 714-483-2104
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95189029
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN61543424
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP70033558
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License Number State | WA
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