Provider Demographics
NPI:1154883494
Name:GIVEN, NICOLA (CNM ARNP)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:GIVEN
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3504
Mailing Address - Country:US
Mailing Address - Phone:360-802-5760
Mailing Address - Fax:253-857-1489
Practice Address - Street 1:1818 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3504
Practice Address - Country:US
Practice Address - Phone:360-802-5760
Practice Address - Fax:253-857-1489
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60801960163W00000X
WAAP60978492367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2141978Medicaid