Provider Demographics
NPI:1215342654
Name:NISHIZAWA, SAYURI (LAC, EAMP)
Entity type:Individual
Prefix:
First Name:SAYURI
Middle Name:
Last Name:NISHIZAWA
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 W LAKE SAMMAMISH PKWY NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4236
Mailing Address - Country:US
Mailing Address - Phone:425-890-2298
Mailing Address - Fax:
Practice Address - Street 1:15650 NE 24TH ST
Practice Address - Street 2:C-2
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2460
Practice Address - Country:US
Practice Address - Phone:425-890-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60434441171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist