1326126186 NPI number — MS. MONICA NELSON ARNP

Table of content: MS. MONICA NELSON ARNP (NPI 1326126186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326126186 NPI number — MS. MONICA NELSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
MONICA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKE
Provider Other First Name:
MONICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326126186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 S J ST FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-274-7505
Provider Business Mailing Address Fax Number:
206-855-7697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1608 S J ST FL 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-274-7505
Provider Business Practice Location Address Fax Number:
206-855-7697
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WN0800X , with the licence number:  RN00086584 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WR0006X , with the licence number: RN00086584 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: AP30003764 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2138480 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9643776 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".