Basic Information
| Provider Information | |||||||||
| NPI: | 1154883494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIVEN | ||||||||
| FirstName: | NICOLA | ||||||||
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| Credential: | CNM ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 COLE ST | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608025760 | ||||||||
| FaxNumber: | 2538571489 | ||||||||
| Practice Location | |||||||||
| Address1: | 1818 COLE ST | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608025760 | ||||||||
| FaxNumber: | 2538571489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60801960 | WA | N | Nursing Service Providers | Registered Nurse | 367A00000X | AP60978492 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 2141978 | 05 | WA | MEDICAID |