Provider Demographics
NPI:1194556795
Name:NIKOLAS STEVEN RADEMAKER
Entity type:Organization
Organization Name:NIKOLAS STEVEN RADEMAKER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NIK
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-FNP
Authorized Official - Phone:509-954-9786
Mailing Address - Street 1:9103 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1251
Mailing Address - Country:US
Mailing Address - Phone:509-467-6060
Mailing Address - Fax:509-467-6518
Practice Address - Street 1:9103 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1251
Practice Address - Country:US
Practice Address - Phone:509-467-6060
Practice Address - Fax:509-467-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1144996661Medicaid